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Date run 2/27/2014 4:33:26PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/27/2014 <br /> Record Selection Criteria: Facility ID FA0019475 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014255 New Owner ID <br /> Owner Name S PELLEGRI & SONS <br /> Owner DBA S PELLEGRI &SONS <br /> Owner Address 8074 W.DELTA RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 8074 W DELTA RD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019475 10,187,259 <br /> Facility Name S PELLEGRI & SONS <br /> Location 21606 EL RANCHO <br /> TRACY, CA 95304 <br /> Phone 209-835-5718 x0 <br /> •y� Y.� <br /> Mailing Address 8074 W DELTA RD <br /> TRACY, CA 95304 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 21318047 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 AR0034625 New Account ID: : <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name .S PELLEGRI & SONS (Circle One) <br /> Account Balance as of 2/27/2014: $53.00 <br /> (Circle One) <br /> Transfer to ActiveAnactve <br /> Program/Element and Description Record ID Employee ID and.Name Status New Owner? ^Delete <br /> 1958-HM-Farm Operations PR0529208 Active Y N A C-J D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531786 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,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 and/or Standards and State andlor' <br /> Federal Laws. ' <br /> APPLICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: *$25:00= Amount Paid Date ! 1 <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: _ Date_ /Z7 /1 t Account out: Date <br /> COMMENTS: <br />