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Date run 7/29/2008 9:06:11AN SAN JOS' 'IN COUNTY ENVIRONMENTAL HEA" `"DEPARTMENT Report#5021 <br /> Run by Pagel <br /> • Facility Information as of 7/29/2000 <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 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 <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 A Alt Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN 241-030-09 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 7/29/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513642 EE0007289-ALISON YOUNGBLOODInactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511391 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR,PR0509103 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> AST FAC>/=100 M+1 GAL CUMULATIVE PR0515784 EE0002670-MUNIAPPA NAIDU Inactive Y N A I D <br /> 8BILLING INGand COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that It operations will be performed in accordance w.itjn¢all applicable Ordinace Codes and/or Standards 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 Receive <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rptjG�G <br />