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Date run 9/26/2014 10:23:10AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/26/2014 <br /> Record Selection Criteria: Facility ID FA0003469 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0002590 Case Number: 002443 New Owner ID <br /> Owner Name MOREIRA,DANIEL&MARIA <br /> Owner DBA M &A DAIRY LP <br /> Owner Address 14691 S BRENNAN RD <br /> ESCALON, CA 95320 <br /> Home Phone 209-838-6420 <br /> Work/Business Phone Not Specified <br /> Mailing Address 14691 S BRENNAN RD <br /> ESCALON, CA 95320 <br /> Care of M &A DAIRY LP <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0003469 10181171 <br /> Facility Name M &A DAIRY LP <br /> Location 14691 S BRENNAN RD <br /> ESCALON, CA 95320 <br /> Phone 209-838-6420 <br /> Mailing Address 14691 S BRENNAN RD <br /> ESCALON, CA 95320 <br /> Care of M &A DAIRY LP <br /> Location Code 99-UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 20736006 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MOREIRA, DANIEL FRANCISCO <br /> Title <br /> Day Phone 209-838-6420 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003046 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name M &A DAIRY LP (Circle One) <br /> Account Balance as of 9/26/2014: $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 /> 1958-HM-Farm Operations PRO525939 Active Y N A7'�D <br /> 2011-GRADE A DAIRY PR0200178 EE0005362-NICHOLAS WIESEMAN Active Y N A Q D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529185 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534683 Inactive Y N A I D <br /> 4620-DAIRY- WATER SUPPLY WA0515709 EE0004589-KADEANNE LINHARES 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,PHSrEHD hourly charges associated with this facility <br /> 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 Ordinance Codes and/or Standards and State and/or <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 !��/ I ` ( Account out: Date 20 <br /> COMMENTS: L �c�IYUl S S C V /O '4 G <br /> 4— <br />