Laserfiche WebLink
Dale 'y46/2013 1 t:02:41A1 SAN JC* JIN COUNTY ENVIRONMENTAL HEA ]DEPARTMENT Paget <br /> Run by Facility Information as of 3/26/2013Report 75021 <br /> 13 <br /> Record Selection Criteria: Facility ID FA0016858 <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 OW0013699 New Owner ID <br /> Owner Name NOMA VINEYARDS <br /> Owner DBA NOMA VINEYARDS <br /> Owner Address 13600 N CURRY AVE <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 13600 N CURRY AVE <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION ������ <br /> Facility lD/CERS ID FA0016858 10,185,521 <br /> Facility Name NOMA VINEYARDS <br /> Location 13600 N CURRY AVE <br /> LODI, CA 95240 <br /> Phone 209-334-9420 x0 <br /> Mailing Address 13600 N CURRY AVE <br /> LODI, CA 95240 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 06113258 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 AR0029740 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name NOMAVINEYARDS (Circle One) <br /> Account Balance as of 3/26/2013: $53.00 <br /> (Circle One) <br /> Transfer o Acgve/Inactve <br /> PrograMElement and Description Record ID Employee ID and Name Status New OvmeO Delete <br /> 1958-HM-Farm Operations PR0525043 Active Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0529276 EE0000753-WILLY NG Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH PR0532124 Inactive Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Ne undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific,PHS/EHD 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 ander Standards and State ands <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / / <br /> Program Records to be TRANSFERE -$25.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: Amount Paid Date / / 0 <br /> Payment Type Check Number Received b <br /> REHS: �� � Date�/ c'/ �3 Account out: Date / _ <br /> COMMENTS: it <br /> �iJ h�Ti I�.�Ti MENU HEpEZH <br /> ENpE MITISERVlia <br />