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Date run 4/11/2014 3:17:29PA SAN JO TAN COUNTY ENVIRONMENTAL HEA' 1 DEPARTMENT Report 115021 <br /> Run by Pagel <br /> Facility Information as of 4/11/20 4 <br /> Record Selection Criteria: Facility ID FA0021646 <br /> Make changes/comactions 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 OW0017809 New Owner ID <br /> Owner Name MULLER, LYNN <br /> Owner DBA <br /> Owner Address 15191 E HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 465 <br /> LOCKEFORD, CA 95237 <br /> care of MULLER, LYNN <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021646 <br /> Facility Name MULLER, LYNN <br /> Location 15191 E HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Phone 209-712-0498 <br /> Mailing Address PO BOX 465 <br /> LOCKEFORD, CA 95237 <br /> Care of MULLER, LYNN <br /> Location Code 99-UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 01912016 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 AR0039258 New Account ID: <br /> Mail Invoices to Facility ' US (j of Mail Invoices to: Owner / Facility / Account <br /> Account Name MULLER J J ,�/ Circle One) <br /> Account Balance as of 4/11/2014: 5 0 <br /> (Circle One) <br /> Transfer to ActivellnacNe <br /> PrograWElement and Description Record ID Employee ID and Name Status New owner? Delete <br /> 1958-HM-Farm Operations PRO537597 Active Y N A \J D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT'. 1,the undersigned owner,operator or agent of some,acknowledge that all site,andor protect 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 certify Nat all operations will be pedormed m accordance with all applicable Ordinance Codes ander Standards and State ander <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�TY�JPe Check Number Receiv <br /> REHS: h ITf11� �� Date / Imo/ t Account out: Date / l <br /> COMMENTS: <br /> lea Zdv kt)v lufz� D r � �S � � (�ti vk �- � �- <br /> �rJ � leu ��' C�.ec'�.L.� <br /> n� ,� r\ <br /> UL, .,nr,� Haler} rX <br /> e o <br /> a <br /> ,1i �o S N 5�n- <br />