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Date run 1/27/2014 9:16:11AN SAN JOIN COUNTY ENVIRONMENTAL HEALODEPARTMENT Report#5021 <br /> Run 111 Pagel <br /> Facility Information as of 1/27/2014 <br /> Record Selection Criteria: Facility ID FA0010287 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> owner ID OW0008287 Case Number: 7614 New Owner ID <br /> Owner Name BRITZ-SIMPLOT GROWER SOLUTIONS <br /> owner DBA BRITZ-SIMPLOT GROWER SOLUTIONS <br /> Owner Address 3265 W FIGARDEN DR <br /> FRESNO, CA 937113906 <br /> Home Phone Not Specified <br /> Work/Business Phone 559-448-8000 <br /> Mailing Address PO BOX 9050 <br /> FRESNO, CA 93790-9050 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010287 10138541 <br /> Facility Name BRITZ-SIMPLOT GROWER SOLUTIONS <br /> Location 7707 S JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Phone 209-461-6565 x0 <br /> Mailing Address PO BOX 9050 <br /> FRESNO, CA 93790-9050 <br /> Care of <br /> Location Code 99 - UNINCORPORATED ,' Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 18117004 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New Account ID: <br /> Account ID AR0017287 <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Owner <br /> Circle One) <br /> Account Name BRITZ-SIMPLOT GROWER SOLUTIONS <br /> Account Balance as of 1/27/2014: $0.00 (Circle One) <br /> Transferto Active/Inaave <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status New Owneo Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0521174 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 1962-CalARP PROGRAM 2 FACILITY PR0530018 EE0000988-KASEY FOLEY Active Y N A I D <br /> 1995-CalARP FAC STATE SURCHARGE FEE PR0522226 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512575 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PRO514757 EE0000000-HAZ MAT SJC OES Inactive Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510287 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0530758 EE0007379-AMANDA BOERTIEN dive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533842 <br /> BILLING antl COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ardor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this farm. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes endor standards and State andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> PaymentT a Check Number Received by a—I <br /> REHS: i� J�(L@J Date�_/ 1 / Account out: Date <br /> COMMENTS: F— ,S �S n f\ �p� n j n1 V. <br />