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Dulen,n 12/912016 3:58:23PM SAN TOAQUIN COUNTY ENVIRONMENTAI,HEALTH DEPARTMENT Repbta5@7 <br /> Run by Papal <br /> Facility Information as of 12/92016 <br /> Ramraseemoncraaa Faddy 10 FA0004500 <br /> Make changes/earaeetlawns 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 lD OW01103415 New OwnarlD <br /> Owner Name Valley Crest Companies <br /> Owner DBA 28915 EFUNCREST CK RD REE COMPANY !Y Iy �-�,z.� z w <br /> Owner Address <br /> FARMINGTON,CA 95230 <br /> Home Phone Not Specified <br /> Work/Businew Phone 209-5865511 <br /> Mailing Address 28915 FUNCK RD <br /> FARMINGTON,CA 95230 <br /> Cam of <br /> FACILITY FILE INFORMATION _ <br /> Facility ID/CERS ID FA0004500 10181639 <br /> Facility Name VALLEY CREST TREE COMPANY R IGS 1 <br /> Locetion 28915 FUNCK RD E <br /> FARMINGTON,CA 95230 <br /> Phone 209-886.5511 X <br /> Mailing Address 28915 funk mad <br /> farmington,CA 95230 <br /> care of Emory Chow <br /> Local Code 99-UNINCORPORATED ARE Alt Phone <br /> SOS District 004_WINN, CHARLES Fax <br /> APC ?0A <br /> EMail <br /> EMERGENCY NOTIFICATIOM CONTACT INFORMATION Contact Name <br /> Tree C <br /> OaY PhoneNight Phone <br /> ID <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004182 New AanuntlDD <br /> Mail Invoices to AcooUnt Mal Invoices Owner /r.i� Atmum <br /> Account Name EMORY CHOW I( eecnel <br /> Account Balance as of 12/92016: $0-00 <br /> (01ree0ne) <br /> Pngrmn semermama Oescmftn Racoro 10 Employee IO and Name StaNs New Ox n Nieta <br /> 1958-HM-Farm Operations PRO525793 EE0002670-MUNUIPPA NAIDU Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0530613 EE0001421-STAGY RNERA Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO53DS12 EE0000027-CINDYVO madlve Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO535383 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FEE PRO534157 Inacthm Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0461343 EE0000003-VANCE WONG Active Y N A I D <br /> RI W NG end COMPWNCEACIWONAED[iEMEM: I,tlw untlerslpm-V P.mer,apvalm w epeN arseme,etlmvMetlye that UI sib,erMlorpmlert spatllk,PHSIp10 <br /> eremwty ova De omeabe,e PaMlEenale0 estlw OVYNER an NLs ram latro yrtlfy Mtl eOl ae pedwrtetlhyaraen®wW all bervty dwpat essodelel wlM Mit balMy <br /> Federal taws r/y��L�..�y �/p,��^\gyp _ °I�pl�a 1°Ormmta:CaEops anwor SYaneerR+ena Ssb enaror <br /> APPLICANTS SIGNATURE el <br /> rr_`w �7 s"'— Data <br /> Pmgram Records to be TRANSFER@ •S25.00= Amount Paid Dab Y /_ <br /> Water System to be TRANSFERED'. Ameum Paid Dab 1. /_ <br /> Payment Type— /-yn-�—Ctreck Numbs RaoeWad <br /> EHD Staff. Data u Zl-- / i Acmurd dub <br /> COMMEMe; t <br /> �D r�bvt�. rl� OiNi�zc Invakaar <br /> 1T <br /> V�A.P.bMk)V/- c w N <br />