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Date run 12/26/2014 9:05:16A SAN JOF`,j[N COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility 'Information as of 12.12612014 <br /> Record Selection Criteria. Facility ID FA0016797 <br /> Make changes/corrections 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 OW0013638 New Owner ID <br /> Owner Name JOHN WEEKS <br /> Owner DBA JOHN WEEKS <br /> Owner Address 24870 DODDS RD <br /> ESCALON, CA 95230 <br /> Home Phone Not Specified �53 <br /> Work/Business Phone Not Specified <br /> Mailing Address 24870 DODDS RD <br /> ESCALON, CA 95230 t'LSC CIL' n t :A- Lt 5 21 2'L—' <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016797 10185421 <br /> Facility Name JOHN WEEKS <br /> Location 22100 DODDS RD <br /> ESCALON, CA 95230 <br /> Phone 209-838-3048 x0 <br /> Mailing Address 24870 DODDS RD b c'I ��CrC t� ,r 'A <br /> ESCALON, CA 95230 LA S<D-3 ?C� <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOOEL, KEN Fax <br /> APN 20521018 Ell <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029679 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner I Facility I Account <br /> Account Name JOHN WEEKS (Circle one) <br /> Account Balance as of 1212612014: $0.00 <br /> (Circle One) <br /> Transfer to Activeoriactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0524982 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2840-AST EXEMPT FAG < 1,320 GAL PR0530152 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531250 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENTS E,the undersigned owner,operator or agent of same,acknowledge that all site,ancPor project specific,PLISrENO hourly charges associated wrlh this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations w0i be performed in accordance with all applicable Ordinance Codes ancVor Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE- Date -1-/ <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I / <br /> Water System to be TRANSFERED: Amount Paid Date I I <br /> Payment Type Check Number Received by _ <br /> REHS: CL ,v u17 `tom"1 ? Date I 1 3� J Account out: Date <br /> COMMENTS. <br />