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Date run 31512014 1:47:47PM SAN Jf WIN COUNTY ENVIRONMENTAL HEf A DEPARTMENT Report#5021 <br /> Run by Pagel <br /> ... Facility Information as of 3/5/2014 <br /> Record Selecdcn Criteria: Facility ID FAD017425 <br /> Make changes/corrections.in RED ink. <br /> INFORMATION CHANGE(date) S ✓ <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION SSNIFed Tax ID <br /> Owner ID OW0014266 New Owner ID <br /> Owner Name BONFIGLIO & SONS <br /> Owner DBA BONFIGLIO & SONS <br /> Owner Address 20650 GAWNE RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 20650 GAWNE RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0017425 10,186,435 <br /> Facility Name BONFIGLIO & SONS <br /> Location 20650 GAWNE RD <br /> STOCKTON, CA 95215 <br /> Phone 209-464-7875 x0 <br /> Mailing Address 20650 GAWNE RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> Bos District 004 -VOGEL, KEN Fax <br /> APN 18510010 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 AR0030307 New Account ID: <br /> Mail Invoices to Owner yn Mail Invoices to Owner 1 Facility 1 Account <br /> Account Name BONF,4uLV' & SONS�� (Circle One) <br /> Account Balance as of 3/5/2014, $53.00 <br /> �y (Circle One) <br /> Transfer to Activellrnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> jam <br /> 1958-,hM-Farm Operations PR0525610 Active Y N A D <br /> ERW-ELECTRONIC REPORTING STATE SURCHARG PR0533701 lnactiv€ Y N A `r D <br /> WI-LING and COMPLIANCE ACKNOWLEDGEMENT. I,She undersigned owner,operator or agent of same,acknowledge that all site,ancifor project specific,PHSIEHD hourly charges associated with thus 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 andror Standards and Slate ancVcr <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFER= Amount Paid Date / f <br /> Payment TyCheck Number Recei <br /> e e <br /> RFHS �o � vn--� Date 1 ! Account out: Date <br /> COMMENTS: <br /> t <br /> P r6 P <br />