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oei9 mn 2118/2014 9:57:42An SAN JO—vIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT <br /> Repott#5021 <br /> Ranby 1273 1 Paget <br /> Facility Information as of 2/18/2014 <br /> Recard Selection Criteria: Facility ID FA0016806 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION 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 2404 THADDEOUS DR 6N 1z/ tJE <br /> ESCALON, CA 953204882 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016806 10,185,439 <br /> Facility Name RIO VERDE ORCHARDS LP <br /> Location 7303 S HENRY RD <br /> FARMINGTON, CA 95230 <br /> Phone 209-614-9263 xO <br /> Mailing Address 2404 THADDEOUS DR �� ' <br /> ESCALON, CA 953209-882 <br /> Care of <br /> Location Code 99-UNINCORPORATED P Alt Phone <br /> BOB District 004-VOGEL, KEN Fax <br /> APN 18739004 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 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 2/18/2014: $53.00 <br /> (Circle One) <br /> Transferto Activellneme <br /> PrograndElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0524991 Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529951 EE0000753-WILLY NG Active,l Y N A 1 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 protect specific,PHMHD 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 Nat all operations will be performed in accordance with all applicable Ordinance Codes ander Standards am State aMbr <br /> Federzl 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 Recel <br /> REHS: ` Date_/ / Account out: Date / / `� <br /> COMMENTS: <br />