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Data run 9/14/2004 10:47:03AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEAT'rHDEPARTMENT Report ill <br /> Run by <br /> Facility Information as of 9/14/2bw4 Pagel <br /> Record selection Criteria: Fadlity ID FA0009937 <br /> Make changesicorrections in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0003379 New Owner ID <br /> Owner Name KELLOGG SUPPLY INC <br /> Owner DBA KELLOGG GARDEN PRODUCTS <br /> Owner Address 350 W SEPULVEDA AVE <br /> CARSON, CA 90745 <br /> Home Phone Not Specified <br /> Work/BusinessPhone -31-083-0220 <br /> Mailing Address 12686 E LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009937 <br /> Facility Name KELLOGG GARDEN PRODUCTS <br /> Location 12686 E LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Phone -20-972-7313 <br /> Mailing Address 12686 E LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:051-320-02 <br /> BOS District 004-SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016937 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name KELLOGG SUPPLY INC (Circle One) <br /> Account Balance as of 9/14/2004: $0.00 <br /> (Circle One) <br /> Transfer to AcWe/InacNe <br /> Program/Element and Description Record ID Employee ID and Name status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PRO522232 EE0008389-DENNIS CATANYAG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512225 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO521028 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0522233 EE0008389-DENNIS CATANYAG Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509937 EE0000000-HAZ MAT SJC DES Inactive 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/EMD hourly charges associated with Nis <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 and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / I <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 I / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />