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Date run 12/24/2019 11:29:50/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/24/2019 <br /> Record Selection Criteria: Facility ID FA0012033 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0007072 Case Number: H00814 New Owner ID <br /> Owner Name PILKINGTON NORTH AMERICA INC <br /> Owner DBA <br /> OwnerAddress 811 MADISON AVE <br /> TOLEDO, OH 43695 <br /> Work/Business Phone Not Specified <br /> Alternative Phone Not Specified <br /> Mailing Address 500 E LOUISE AVE <br /> LATHROP, CA 95330 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0012033 Site Mitigation Facility <br /> Facility Name PILKINGTON NORTH AMERICA <br /> Location 500 E LOUISE AVE <br /> LATHROP, CA 95330 <br /> Phone 209-858-6290 <br /> Mailing Address 500 E LOUISE AVE <br /> LATHROP, CA 95330 <br /> Care of <br /> Location Code 07 - LATHROP Alt Phone <br /> BOS District 003- PATTI, TOM Fax <br /> APN 19812008 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 AR0019120 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CONDOR EARTH TECHNOLOGIES INC (Circle One) <br /> Account Balance as of 12/24/2019: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PR0009276 EE0001699-JOHNNY YOAKUM 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 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 and/or Standards and State and/or <br /> Federal Laws. <br /> i <br /> APPLICANTS SIGNATURE: Date r / i*/ 4?0 V� <br /> Program Records to be TRANSFERED: G$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: . Date / / Account out: J Date <br /> COMMENTS: <br /> Invoice#: <br />