Laserfiche WebLink
Date un X1912013 11:00:03AI SAN J `..dJIN COUNTY ENVIRONMENTAL HEA N%.11DEPARTMENT Report 45021 <br /> Runi;p <br /> Facility Information as of 9/19/2013 Pagel <br /> Record Selectlon Criteria: Facility ID FA0006174 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner ID OW0004923 New Owner ID <br /> Owner Name EARTH GRAINS BAKING COMPANIES INC <br /> Owner DBA EARTHGRAINS BAKING CO INC THE <br /> Owner Address S PO BOX 976 WAY 71913 <br /> HORSHAM, PA 19044 , 3 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 976 p B 6Z F 11716 <br /> HORSHAM, PA 19044 v 7610 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID I CERS ID FA0006174 10,182,041 <br /> Facility Name EARTHGRAINS BAKING CO INC <br /> Location 2651 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-946-0772 <br /> Mailing Address PO BOX 976 <br /> HORSHAM, PA 19044 ,r V <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16912003 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 AR0007255 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility 1 Account <br /> Account Name EARTHGRAINS BAKING CO INC (Circle One) <br /> Account Balance as of 911912013: $325.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519612 EE0009817-ROBERT LOPEZ Inactive Y N A 1 D <br /> 2220-SM HW GEN<5 TONS/YR PR0513821 EED001421 -STACY RIVERA Inactive Y N A 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511699 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PR0504354 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509411 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0531049 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0528634 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532299 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PHSIEHD hourly charges associated with this facility <br /> 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 accordance with all applicable Ordinance Codes andror Standards and State and+or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: �eC /� a� Date I I <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received y <br /> RENS: Date 1 I Account out: Date 9 1 13 <br /> COMMENTS: �//) ! r, 1 1 1,� l <br /> IrC l� 11 <br />