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Date run 10/3012017 1:10:51P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by DONNA Pagel <br /> Facility Information as of 10/30/2017 <br /> Record Selection CritedaL Facility ID FA0017048 <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 OW0013889 New Owner ID <br /> Owner Name KAGEHIRO RANCHES INC <br /> Owner DBA KAGEHIRO RANCHES INC <br /> Owner Address 26977 S LAMMERS RD <br /> TRACY, CA 95377 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 26977 S LAMMERS RD <br /> TRACY, CA 95377 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility IDICERS ID FA0017048 10185811 <br /> Facility Name KAGEHIRO RANCHES INC <br /> Location 7200 W ELEVENTH ST <br /> TRACY, CA 95376 <br /> Phone 209_835_8094 x0 <br /> Mailing Address 26977 S LAMMERS RD <br /> TRACY, CA 95377 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 25020002 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029930 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility 1 Account <br /> Account Name KAG HI NCHES INC (Circle Ore) <br /> Account Balance as of 10/30 7: Z c?! -K <br /> /C (Circle One) <br /> 777l Transfer to Activellnactve <br /> Program/Element and Descnption Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525233 EE0002670-MUNIAPPA NAIDU Active Y N D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO534632 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,PHSlEH❑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 ancifor Slardards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date ! ! <br /> Water System to be TRANSFERED: Amount Paid Date / 1 <br /> Payment Type Check Number Rgceive <br /> EHD Staff: Date ZL2 ! ci /L:7— Account out: Date Nb 1-2.0 1�� <br /> COMMENTS: f� <br /> �L_ Ja2 <br /> r Invoice#: <br /> S tync-�e. 'Za 1 S-. <br /> GZdw ism <br />