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Date run 2/25/2014 2:27:30P11 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/25/2014 <br /> Record Selection Criteria, Facility ID FA0017272 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID <br /> Owner ID OW0014113 New Owner ID <br /> Owner Name RADEMACHER FARMS <br /> Owner DBA RADEMACHER FARMS <br /> Owner Address 1540 N DUNCAN RD <br /> LINDEN, CA 95236 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1540 N DUNCAN RD <br /> LINDEN, CA 95236 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility IDICERS ID FA0017272 10,186,187 <br /> Facility Name RADEMACHER FARMS <br /> Location 1540 N DUNCAN RD <br /> LINDEN, CA 95236 <br /> Phone 000-000-0000 x0 <br /> Marling Address 1540 N DUNCAN RD <br /> LINDEN, CA 95236 <br /> Care of _ <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 10514013 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 AR0030154 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name RADEMACHER FARMS (Circle One) <br /> Account Balance as of 2/25/2014:4&3-0(� <br /> (Circle One) <br /> Transfer to Aclivel9naelve <br /> ProgramlElerl and Description Record ID Employee ID and Name Status New Owner? Delele <br /> 1958-HM-Farm Operations PR0525457 Active Y N A D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0530718 EE0000753-WILLY NG Active,/ Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532572 Inactive 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.PHSIEHD 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 ancvor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE- Date 1 ! <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: Amount Paid Date 1 f <br /> Payment Type Check Number ReceiXegi 1>y <br /> REHS: Date 7.1 Z'5 /t+ Account out: �f Date l l <br /> COMMENTS: r <br /> p�,� G4�t� p�D e ' •-- �//1) �/ wig c�"c,'— ) r+y�'/f+J -C <br /> 1 rto GG.�w Yfc o. it ►mac.-..f,^; <br /> 6r (fre -t)— <br />