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Date run 3/25/2008 8:05:22AN SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by 4006 Pagel <br /> Facility Information as of 3/25/20 <br /> Record Selection Criteria: Facility ID FA171000649 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0000518 New Owner ID <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 ares 5. <br /> r�-e X53 <br /> QLENBAI:E, CA 91203 C-0 s [M es 6( ! GrQ- a a� <br /> Careof BINAYAK A CHARYA <br /> Location Code 05- RIPON APN 25938001 <br /> BOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000648 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name NESTLEMILLS BROS (Circle One) <br /> Account Balance as of 3/25/2008: $784.00 <br /> (circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omen 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 YOUNGBLOODInactive Y N A I D <br /> 2960-RWQCB SITE PR0009051 EE0003611 -FRANK GIRARDI 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 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 Ordinace Codes and/or Standards and <br /> Slate anclor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type �1—�—Check Number Received by cy <br /> REHS: "'77" t • //'�-�d�t�t� Date 3/ / Account out: Date .3 /tel Oa <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />