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Dae^^ 3/19/2015 2:57:04pn <br /> Run by _ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 95027 <br /> Facility Information as of 3/19/2015 Page' <br /> Recoro Selection Criteria: Faaliry ID FA0017408 <br /> Make changes/corrections in RED ink <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID <br /> OW0014249 New Owner ID <br /> Owner Name MANUELSILVA <br /> Owner DBA MANUELSILVA <br /> Owner Address 2091 E GRANT LINE RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-836-3440 <br /> Mailing Address 2091 E GRANT LINE RD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017408 10186407 <br /> Facility Name MANUELSILVA <br /> Location 24080 S BIRD RD <br /> TRACY, CA 95304 <br /> Phone 209-564-8309 x <br /> Mailing Address 2091 E GRANT LINE RD <br /> TRACY, CA 95304 <br /> Care of Michael Silva <br /> Location Code 99 - UNINCORPORATED.4 Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 23910001 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 AR0030290 New Account 10: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MANUELSILV9� `� (Circle One) <br /> Account Balance as of 3/19/2015: $53M A-p 5 <br /> I (Circle One) <br /> P amen and Description Record ID Employee ID and Name M''�' 1 Transferto AcWeMechre <br /> I/ ' s tws New Omer? /yet/eto <br /> 1958- -Farm Operations PRO525593 EE0002474-MICHAEL PARISSI Active Y N A( / D <br /> 0-AST EXEMPT FAC <1,320 GAL PRO529297 EE0000753-WILLY NG Inactive Y N A "7 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532814 Inactive Y N A I D <br /> BILLor al NG �I be COMPLIANCE <br /> the ACKNOWLEDGEMENT: I,Ne undersigned owner,operator or agent of same,acknowledge that ell site,anNor project aPerXc,PHSIEHO hourly dterges aacaiated weh thla fatility <br /> ry Party idemified asthe OWNER on thisfonrt l also certify that all operations will be performed in accordance with all applicable Ordinance Codesanddor StandaM WdStateerWar <br /> Federal Laws. yp'r <br /> APPLICANTS SIGNATURE: T �-���� t[�il.t7[�� 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/by <br /> RENS: Date_/_/_ Amount out: Date_I <br /> COMMENTS: <br /> 1;-111 FIsS��,�, A 41eak� �So <br /> u)-DAX " , pot <br /> 5t7'k.`\5 ' !L� &UbI Ce_ <br />