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Date run 9/23/2004 8:47:05AN SAN JC IN COUNTY ENVIRONMENTAL HEAW DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/23/2004 <br /> Record Selection Criteria: Facility ID FA0006674 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0005425 New Owner ID <br /> Owner Name OWENS BROCKWAY <br /> Owner DBA OWENS-BROCKWAY GLASS CONTAINER <br /> Owner Address 14700 W SCHULTE RD <br /> TRACY, CA 953768628 <br /> Home Phone Not Specified <br /> Work/Business Phone 419-247-0671 <br /> Mailing Address 14700 W SCHULTE RD <br /> TRACY, CA 95377 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006674 <br /> Facility Name OWENS BROCKWAY <br /> Location 14700 W SCHULTE RD <br /> TRACY, CA 95377 <br /> Phone 209-836-8269 <br /> Mailing Address 14700 W SCHULTE RD <br /> TRACY, CA 95377 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:209-240-24 <br /> BOS District 005-ORNELLAS, LEROY SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009022 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name OWENS BROCKWAY (Circle One) <br /> Account Balance as of 9/23/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2213-HAZ WASTE CE FAC STATE SERVICE FEE PR0506888 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2214-CalARP FAC STATE SURCHARGE FEE PR0518982 EE0007289-ALISON YOUNG BLOODActive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511596 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2226-CalARP PROGRAM PRO514557 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2233-HAZARDOUS WASTE CESQT FACILITY PR0506887 EE0007380-STEVEN SHIH Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0519535 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2249-RCRA GEN 50<250 TONS PR0220086 EE0007380-STEVEN SHIH Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84) PR0503940 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PRO516327 EE0000451 -STEVE SASSON Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0506889 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0505610 EE0000249-MARY MEAYS Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0460825 EE0001699-JOHNNY YOAKUM 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 /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />