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Fby <br /> 2/18/2014 3:30:48PR SAN JO`�AN COUNTY ENVIRONMENTAL HEA' J DEPARTMENT <br /> Report x5021 <br /> Facility Information as of 2/18/2014 Pagel <br /> Record Selection Criteria. Facility ID FA0019475 <br /> Make changes/corrections In RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID OW0014255 New OwnerlD <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 lD/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 /> 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 2/18/2014: $53.00 <br /> (Circle One) <br /> Program/Element antl Description RecordID Employee 10 Transfer to Active/Ina We <br /> and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO529208 Active Y N ACil D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531786 Inactivc Y N A Y D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENTI,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHO 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 andor Standards and State and'« <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 Type �}–�—Check Number Receive <br /> RENS: T ✓l'�1, SS/' Date 2 / ISS/ (W Account out: Date Z <br /> COMMENTS: <br /> 4:�-` ss� z- ilr-i`f <br />