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Date run 4/15/2008 1:31:29PA SAN JO�UIN COUNTY ENVIRONMENTAL HEA�H DEPARTMENT Report 45021 <br /> Run by r Pagel <br /> Facility Information as of 4/15/2 <br /> Record Selection Criteria: Facility ID FA0008093 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(dale) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0006691 New Owner ID <br /> Owner Name CONTINENTAL GRAIN COMPANY <br /> Owner DBA <br /> Owner Address 222 S RIVERSIDE 1100 <br /> CHICAGO, IL 60606 <br /> Home Phone Not Specified <br /> Work/Business Phone 312-207-5100 <br /> Mailing Address 222 S RIVERSIDE STE 1100 <br /> CHICAGO, IL 60606 <br /> Care of MBROWN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0008093 <br /> Facility Name CONTINENTAL GRAIN CO <br /> Location 9504 S HARLAN RD <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-982-1121 <br /> Mailing Address 222 S RIVERSIDE <br /> CHICAGO, IL 60606 <br /> Care of M BROWN <br /> Location Code 99 - UNINCORPORATED AREA APN: <br /> BOS District 001 - GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0015386 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CONTINENTAL GRAIN COMPANY�rr�� (Circle One) <br /> Account Balance as of 4/15/2008: $0.00 0' <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Progran/Element and Description Record lD mployeelDand Name Status New Owner? Delete <br /> 2960-RWQCB SITE PRO50846Z EE0006219-LORI DUNCAN 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 parry identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordmace Codes and/or Standards and <br /> State anifor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Dale <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type se=e Check Number Received by <br /> REHS: Date / / Account out: Date / I <br /> COMMENTS: a 4 <br /> \\phsehsgl-nt\apps\envisions\reports\5021.rpt <br />