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Date run 7/30/2015 11:49:59AI SAN JOA�iN COUNTY ENVIRONMENTAL HEAL-..�EPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/30/2015 <br /> Record Selection Criteria: Facility ID FA0017395 <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 OW0014236 New Owner ID : <br /> Owner Name DASILVA DAIRY 14L e1 V,s2 S�ld�t / Gt01 <br /> Owner DBA DASILVA DAIRY <br /> Owner Address 16880 S HENRY RD {� j J ,{ <br /> ESCALON, CA 95320 za <br /> t <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 16877 HENRY RD <br /> ESCALON, CA 953209426 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017395 10186387 <br /> Facility Name DASILVA DAIRY 1�i�i�M <br /> Location 16551 S HENRY RD <br /> ESCALON, CA 95320 <br /> Phone 209-838-1121 ria' ��S- (� 1. <br /> Mailing Address 16877 HENRY RD f S 8 �? d <br /> ESCALON, CA 953209426 ��(fi• Gdk <br /> Care of <br /> Location Code 99 -UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 22916033 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION _ <br /> Contact Name , <br /> Title <br /> Day Phone cr ti <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION �7 � <br /> Account ID AR0030277 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility ! Account <br /> Account Name DASILVADAIRY �I (Circle One) <br /> Account Balance as of 7/30/2015: $787.00 (Gj D <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee 10 and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525580 EE0002474-MICHAEL PARISSI Active Y N AI D <br /> 2220-SM HW GEN<5 TONS/YR PR0529954 EE0002670-MUNIAPPA NAIDU Inactive Y N A DI <br /> 2830-AST FAC -SPCC EXEMPT PR0529953 EE0009001 -ELENA MANZO Active Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532762 Inactive Y N A 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 andtor Standards and State and/or <br /> Federal Laws. <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 Received4y <br /> ! <br /> EHq Staff: Wi IV/"flt� Date�_/ 0 _/�� Account out: Date l %U 1�✓ <br /> COMMENTS: Invoice <br /> 1 #: <br />