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Date run 6/6/2016 9:50:16AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run EY Pagel <br /> Facility Information as of 6/6/2016 <br /> Record Selection Cntena: Facility ID FA0022460 <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 OW0019888 New Owner ID <br /> Owner Name Ronn and Lance Leffler <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-986-1045 <br /> Mailing Address 6488 E Eight Mile Rd <br /> Stockton, CA 95212 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022460 10421899 <br /> Facility Name Go Bears Ranch, LLC <br /> Location 6488 E EIGHT MILE RD <br /> Stockton, CA 95212 <br /> Phone 209-986-1045 x <br /> Mailing Address 6488 E. Eight Mile Rd. <br /> Stockton, CA 95212 <br /> Care of Ronn and Lance Leffler <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 063-040-16 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 AR0041103 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Holly Renfro (Circle one) <br /> Accc t Balance as of 6/6/2016: $0.00 <br /> q5` Circle One) <br /> g 1J <br /> Transfer ActiDelete ve <br /> gramrElemenl and Descdplion Record ID Employee ID and Name Status New OwneR Delete <br /> 1 1 -HMBP-Regular-Primary Location PRO539275 EE0008709-JAMIE LIMA Active Y N A I D <br /> lLI and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor 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 canify that all operations will be performed in accordance with all applicable Ordinance Codes anclor Standards and State anclor <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 Typl� Check Number Received b <br /> EHD Staff: l�\1�Y\a. Date / / Account out: 445=Date /�/ <br /> COMMENTS: <br /> Invoice#: <br />