Laserfiche WebLink
Date run 3/5/2018 1:17:33PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3151201$ <br /> Record Selection Criteria: Facility ID FA0017538 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) vS <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN I Fed Tax ID <br /> Owner ID OW0014379 New Owner ID <br /> Owner Name GARDELLA FARMS <br /> Owner DBA GARDELLA FARMS <br /> Owner Address -3003 N-96NGA ,[-R$- 45'y0 FIor,r, Rd. Ste F-355' <br /> -LIN0EN CA_95236- 5'r c.(cpm en ho " gS 8 3 <br /> Home Phone Not Specified 1+6 _SQA _a31 <br /> Work/Business Phone_434_&$g_48a.T <br /> Mailing Address RQ BOX 664 <br /> LINDEN, CA 95236 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0017538 10186611 <br /> Facility Name GARDELLA FARMS <br /> Location 3003 N DUNCAN RD <br /> LINDEN, CA 95236 <br /> Phone X <br /> Mailing Address PQ43G�(_664 �fe, F-?SS <br /> ---L NDE—w, e C 95 - S4 L(4MCO tQ c 4 q�8a <br /> Care of _jGeVardeft kende}h (-rarde)1c. <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 10509016 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 AR0030420 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility I Account <br /> Account Name GARDELLA FARMS (Circle One) <br /> Account Balance as of 31512018: $594.00 <br /> (Circle One) <br /> Transfer to Activellnacrie <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner'? Delete <br /> 1958-HM-Farm Operations PR0525723 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2220-SM HW GEN<5 TONSIYR PRO530563 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO530562 EE0000027-CINDY VO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532417 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER an this form. I also cei that all operations will be performed in accordance with all applicable Ordinance Codes andlor Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Receive1db <br /> EHD Staf: �/'�nsc r �u fc� r upr� Date 03 1 0a` I cam' Account out: Date <br /> COMMENTS: <br /> If1V01Ce#: <br />