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Date run 5/13/2008 9:17:06AN SAN JQ JIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT Report#5021 <br /> Run by � Pagel <br /> 1 11 Facility Information as of 5/13/2008 <br /> Record Selection Criteria: Facility ID FA0009103 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> SSN/Fed Tax ID <br /> Owner ID OW0007103 Case Number: H01207 New Owner ID <br /> Owner Name WOODWARD PROPERTIES LTD <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-239-9406 <br /> Mailing Address 874 E WOODWARD AVE <br /> MANTECA, CA 95337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009103 <br /> Facility Name BROWN SAND INC <br /> Location 874 E WOODWARD AVE rTV <br /> MANTECA, CA 95337 <br /> Phone 209-234-1500 <br /> Mailing Address PO BOX 1429 <br /> LATHROP, CA 95330 <br /> Care of ROBERT BROWN JR <br /> Location Code 99 - UNINCORPORATED P APN: 241-030-09 <br /> BOS District 005 - ORNELLAS, LEROY SIC Code: <br /> Alt Phone Fax EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016103 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name BROWN SAND INC (Circle One) <br /> Account Balance as of 5/13/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name S s New Owner? elete <br /> 2220-SM HW GEN<5 TONS/YR PR0513642 EE0007289-ALISON YOUNGBLO nactive 1 Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511391 EE0000000-HAZ MAT SJC OE Inactive I Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0515784 EE0007289-ALISON YOUNG ODlnactive f Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0509103 EE0000000-HAZ MAT SJC OESf Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all sit and/or projec ecific,PHS/EHD hourly charges associat ith this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in a rdanc all applicable Ordinate Codes and/or Stan ds and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date <br /> Payment Type Check Number Receiv <br /> RENS: Date,�/ /J /o F Account out: <br /> COMMENTS: <br /> 1 A AA C VA <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />