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Date run 6/9/2009 11:21:27AIV SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/9/2009 <br /> Record Selection Criteria: Facility ID FA0004395 <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 OW0003310 New Owner ID <br /> Owner Name DIAMOND PET FOOD PROCESSOR LLC <br /> Owner DBA DIAMOND PET FOOD PROCESSORS OF <br /> Owner Address 250 E ROTH RD <br /> LATHROP, CA 95330 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-983-4900 <br /> Mailing Address 250 E ROTH RD <br /> LATHROP, CA 95330 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004395 <br /> Facility Name DIAMOND PET FOOD <br /> Location 250 E ROTH RD <br /> LATHROP, CA 95330 <br /> Phone 209-983-4900 x0 <br /> Mailing Address 250 E ROTH RD <br /> LATHROP, CA 95330 <br /> Care of <br /> Location Code 07 - LATHROP Alt Phone <br /> BOS District 003 - BESTOLARIDES Fax <br /> APN 19603001 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 AR0004077 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DIAMOND PET FOOD (Circle One) <br /> Account Balance as of 6/9/2009: $483.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0527662 EE0005642-MICHELLE HENRY Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO515843 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520839 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0503264 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR,PR0515844 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0524067 EE0000060-JENNIFER FRASE Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0461204 EE0005838-ADRIENNE ELLSAESSEActive 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S 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 Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />