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Daterun '4/25/2012 3:47:17PR SAN JOAy"IIN COUNTY ENVIRONMENTAL HEALTu <br /> RVn blu — ' .DEPARTMENT RePon#W21 <br /> y Facility Information as of 4/25/20 wstw Pagel <br /> Record Selection Criteria: Facility ID FA0009093 <br /> Make changes/comections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007093 Case Number: H01102 New Owner ID <br /> Owner Name CAMPBELL SOUP CO <br /> Owner DBA CAMPBELL SOUP SUPPLY CO <br /> Owner Address PO BOX 31390 <br /> STOCKTON, CA 95213 <br /> Home Phone Not Specified <br /> Work/Business Phone 856-342-4800 <br /> Mailing Address PO BOX 280700 <br /> EAST HARTFORD, CT 06128 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility 10 FA0009093 <br /> Facility Name CAMPBELL SOUP SUPPLY CO <br /> Location 760 INDUSTRIAL DR <br /> STOCKTON, CA 95206 <br /> Phone 209-982-4586 <br /> Mailing Address l bf' <br /> C-rTro6128 l .f.. L j 1 rr l n�, Z' <br /> Care of "/-"u-(L- b C 1 t <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax zeth - <br /> ol <br /> APN 17728024 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 AR0016093 New Account ID: <br /> Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CAMPBELL SOUP SUPPLY CO (Circle One) <br /> Account Balance as of 4/25/2012: $790.00 <br /> (Circle One) <br /> Transfer toActivNlnacive <br /> PfogrannElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO519377 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO513634 EE0001421 -STAGY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOtPRO511381 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-Ca1ARP PROGRAM PR0514525 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0504467 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0509093 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATNPR0528668 EE0001421 -STACY RIVERA Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCFLPRO532926 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ands project specific.PHSIEHD bwdy charges associated with this facility <br /> or activity will be tilled 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 andsor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / <br /> Payment Type Check Number Received by '7 <br /> REHS: Date / / Account out: _ Date 4 17i! I It [/ <br /> COMMENTS: 1 <br /> c.�uAyA vy.al.\,uy 2��C� � <br /> �u <br />