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Dare an 12/24/2014 11:24:281 SAN JO�sUIN COUNTY ENVIRONMENTAL HEAD i DEPARTMENT Report C5021 <br /> Pagel <br /> Run by Facility Information as of 12/24/2014 <br /> Record Selection Criteria: Facility ID FA0016806 <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 OW0013647 New Owner ID <br /> Owner Name RIO VERDE ORCHARDS LP <br /> Owner DBA RIO VERDE ORCHARDS LP <br /> Owner Address 2404 THADDEOUS DR <br /> ESCALON, CA 953201882 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 27155 TIFFANI LN -A1 i g53 —t ' <br /> ESCALON, CA 95320 <br /> Care of TERRA VERDE INC <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016806 10185439 <br /> Facility Name RIO VERDE ORCHARDS LP <br /> Location 7303 S HENRY RD <br /> FARMINGTON, CA 95320 <br /> Phone 209-614-9263 x0 <br /> Mailing Address 2715, TIFFANI LN 2-7153 T-���'' L✓1 <br /> ESCALON, CA 95320 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 18739004 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029688 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name RIO VERDE ORCHARDS LP (Circle One) <br /> Account Balance as of 12/24/2014: $0.00 <br /> (Circe One) <br /> Transfer to AcWellnaWe <br /> Prograr/Element and Description Record ID Employee ID and Name Slaw. New Ovmeft Delete <br /> 1958-HM-Farm Operations PRO524991 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529951 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534347 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD hourly charges associated with this tacitly <br /> or activity will be billed to the party identified as the OWNER on this form, l also certify that all operations will be perdrmed in accordance with all applicable Ordinance Codes ander Standards and State r,do, <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 Type Check Number Receive y <br /> REHS: 31 Q,Q,/T_ Date, —/,C2Lj / Account out 146 Date <br /> COMMENTS: u <br />