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Date run 1/20/2011 2:31:59PN SAN JUIN COUNTY ENVIRONMENTAL HE.&DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/20/2011 <br /> Record Selection Criteria: Facility ID FA0000649 <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 OW0000518 New Owner 10 <br /> Owner Name NESTLE FOODS CORP <br /> Owner DBA NESTLE FOODS CORP <br /> Owner Address 230 INDUSTRIAL <br /> RIPON, CA 95366 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-599-4161 <br /> Mailing Address 230 INDUSTRIAL <br /> RIPON, CA 95366 <br /> Care of NESTLE FOODS CORP <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000649 <br /> Facility Name NESTLE/HILLS BROS <br /> Location 230 INDUSTRIAL DR <br /> RIPON, CA 95366 <br /> Phone 209-599-4161 <br /> Mailing Address 800 N BRAND BLVD <br /> GLENDALE, CA 91203 <br /> Care of STORY, KIM <br /> Location Code 05 - RIPON Alt Phone <br /> BOS District 005 -ORNELLAS, LEROY Fax <br /> APN 25938001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION 7 <br /> Account ID <br /> AR0000648 /.A New Account ID: <br /> Mail Invoices to Account ( Mail Invoices to: Owner / Facility / Account <br /> Account Name NESTLEMILLSBROS / (Circle One) <br /> Account Balance as of 1/20/2011: $-549.00 � <br /> (Circle One) <br /> Program/Element and Description Transfer to Active/Inacive <br /> Record 10 toYea ID aM Name Status New <br /> Owner? Delete <br /> 2229-GEN 50<250 TONS PERMIT PR0220104 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2231 -HAZARDOUS WASTE PBR FACILITY PRO527658 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0505647 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2960-RWQCB SITE PR0009051 Ec00101911 -FRANK GIRA R44— Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0460794 EE0005838-ADRIENNE ELLSAESSEInactive 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 ass iated with this <br /> facility or activitywill be billed to the parry identified as the OWNER on this form. I also certify"tall 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: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: -t- Date 1 /L Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />