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_ - Report#5021 <br /> Date run 516/2013 4:07:23PM SAN JC�UIN COUNTY ENVIRONMENTAL HEA,.i DEPARTMENT Pagel <br /> Ron by Facility Information as of 5/6/2013 <br /> Record Selection Criteda: Facility lD FA0017152 <br /> Make changesicorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013993 New Owner ID <br /> Owner Name J PIAZZA FARMS INC <br /> owner DBA J PIAZZA FARMS INC <br /> Owner Address 711 CROSS ST <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 711 CROSS ST <br /> LODI, CA 95242 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0017152 10,185,977 <br /> Facility Name J PIAZZA FARMS INC <br /> Location 341 E ACAMPO RD <br /> LODI, CA 95240 <br /> Phone 209-368-0765 x0 <br /> Mailing Address 711 CROSS ST <br /> LODI, CA 95242 <br /> Care of <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 01309021 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030034 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility ! Account <br /> Account Name J PIAZZA FARMS INC (Circle One) <br /> Account Balance as of 5/6/2013: $53.00 <br /> (Circle One) <br /> Transfer to Active ractve <br /> Prograrl lement and Description Record ID Employee to and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525337 Active Y N A D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528976 EE0001422-ARIS CACAPIT Active,Exempt Y N A �B D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0532506 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PHSIEHD hourly charges associated with this facility <br /> a activity will be billed to the parry identified as the OWNER on this fort I also certify that all operations will be performed m accordance with all applicable Ordinance Codes anddor Standards and State anctor <br /> Federal Laws. <br /> APPLICANTS 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 b <br /> REHS: Date l_ y,] l Account out: Date <br /> COMMENTS <br /> �f,C-��✓Q/✓�L-Ili �1./` lL r-L� . <br />