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Date run 7/26/2004 10:24:45AI SAN JUIN COUNTY ENVIRONMENTAL RES DEPARTMENT Report#6021 <br /> Run by Paget <br /> Facility Information as c. 7/26/21 4 <br /> Record Selection Criteria: Facility ID FA0009485 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0007485 Case Number: H04485 New Owner ID <br /> Owner Name FRENCH CAMP GRAIN ELEVATOR LLC <br /> Owner DBA FRENCH CAMP GRAIN ELEVATORS LL <br /> Owner Address 9504 S HARLAN RD <br /> FRENCH CAMP, CA 95231 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-465-5871 <br /> Mailing Address PO BOX 97 <br /> FRENCH CAMP, CA 95231 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009485 <br /> Facility Name FRENCH CAMP GRAIN ELEVATOR <br /> Location 9504 S HARLAN RD <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-982-1121 <br /> Mailing Address PO BOX 97 <br /> FRENCH CAMP, CA 95231 <br /> Care of <br /> Location Code 99 - UNINCORPORATED AREA APN 193-210-02 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016485 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name FRENCH CAMP GRAIN ELEVATOR LLC (Circle One) <br /> Account Balance as of 7/26/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> New Owner? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511773 EE0000000-HAZ MAT SJC IDES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520897 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509485 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner.operator or agent or same,acknowledge that all site,and/or pmjecl specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes andlor Standards and <br /> 5AP11 teann�dlnorFede L,4 Laws cell - g 20- q0 24 -�A� ce �� "�°$ $3 <br /> PLICANT SIGNATURE: o Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: _*$155.00=— Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date_/ /_ Account out: nate-- ----� ----� <br /> COMMENTS: <br /> I <br /> I • <br /> FRAC RITE SERVICES LTD. <br /> GORDON H. BURES, M.Eng.,P.Eng. <br /> Manager of Geo-Engineering <br /> 1510,717-7th Avenue S.W. Bus:(403)265-5533 <br /> Calgary,Alberta,Canada Fax:(403)265.5648 <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt T2P OZ3 Cell:(403)620,5533 <br />