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Data run 8/15/2014 2:22:24PR SAN JO�JIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by Y Pagel <br /> Facility Information as of 8/15/2014 <br /> Record Selection Criteria: Facility ID FA0022527 <br /> Make changeslcorrections 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 OW0020062 New Owner ID <br /> Owner Name Dana R. Crum <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-838-2118 <br /> Mailing Address 16504 Henry Rd <br /> Escalon, CA 95320 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FAD022627 10487242 <br /> Facility Name Crum Family Ranch LLC <br /> Location 16504 Henry Rd <br /> Escalon, CA 95320 <br /> Phone 209-838-2118 x <br /> Mailing Address 16504 Henry Rd <br /> Escalon, CA 95320 <br /> Care of Wendy Stone/Dana R. Crum <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN Eli <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0041207 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name Crum Family Ranch LLC (Circle One) <br /> Account Balance as of 8/15/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activeanadve <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO539414 EE0002474-MICHAEL PARISSI Active 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,PHS/EHD 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 ani Standards and State andor <br /> Federal Lewis <br /> APPLICANT'S 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 Re cei y <br /> REHS: Date /J-5--/ t Account out: Date / /j1L <br /> COMMENTS: <br /> -r-1 <br /> 2ot`-�• 1Nv�a5533y` <br />