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Date run° 6/11/2008 9:41:05Ah SAN JOIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/11/2008 <br /> Record Selection Criteria: Facility ID FA0006852 <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 OW0010694 New Owner ID <br /> Owner Name MILLER SPRINGS REMEDIATION MGT <br /> Owner DBA <br /> Owner Address 2480 FORTUNE DR STE 300 <br /> LEXINGTON, KY 40509 <br /> Home Phone 859-543-2100 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2480 FORTUNE DR STE 300 <br /> LEXINGTON, KY 40509 <br /> Care of PRICE, KEN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006852 <br /> Facility Name OCCIDENTAL CHEMICAL CORP <br /> Location 1904 W CHARTER WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-472-2020 <br /> Mailing Address 2480 FORTUNE DR STE 300 <br /> LEXINGTON, KY 40509 <br /> Care of PRICE, KEN <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -GUTIERREZ, STEVE Fax <br /> APN EMai1: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MILLER SPRINGS REMEDIATION <br /> Title <br /> Day Phone 859-543-2100 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009556 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name GLENN SPRINGS HOLDINGS INC (Circle One) <br /> Account Balance as of 6/11/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omen Delete <br /> 2960-RWQCB SITE PRO505548 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,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 all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS 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 131 Received by <br /> REHS: Date_/ / Account out Date <br /> COMMENTS: <br /> 1 <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />