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Date run 9/23/2004 9:40:OOAk SAN JOA•IN COUNTY ENVIRONMENTAL HEAL <br /> EPARTMENT Report#5021 1 <br /> Pagel <br /> Run by Facility Information as of 9/23/2004 <br /> Record Selection Criteria: Facility ID FA0004570 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0003473 New Owner ID <br /> Owner Name SPRECKELS SUGAR CO <br /> Owner DBA SPRECKELS SUGAR COMPANY <br /> Owner Address PO BOX 60 <br /> TRACY, CA 95378 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-3210 <br /> Mailing Address PO BOX 60 <br /> TRACY, CA 95378 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004570 <br /> Facility Name SPRECKELS SUGAR CO <br /> Location 20500 HOLLY DR <br /> TRACY, CA 95378 <br /> Phone 209-835-3210 <br /> Mailing Address PO BOX 60 <br /> TRACY, CA 95378 <br /> Care of SPRECKELS SUGAR CO <br /> Location Code 03-TRACY APN:212-160-02-2 <br /> BOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004353 New Account ID: <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Facility <br /> (Circle One) <br /> Account Name SPRECKELS SUGAR CO <br /> Account Balance as of 9/23/2004: $0.00 (Circle One) <br /> Transfer to Active/Inactve <br /> New Owner? Delete <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0009165 EE0000997-HARLIN KNOLL 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 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: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date-/-/- Account out: Date <br /> COMMENTS: <br /> \\ph s-eh sq I-nt\apps\envi s ions\re ports\5021.rpt <br />