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Dene ran 1/31/2013 2:22:22PK SAN X`/fUIN COUNTY ENVIRONMENTAL HEA""A DEPARTMENT Report#5021 <br /> Pagel <br /> Run by <br /> Facility Information as of 1/31/2013 <br /> Record Selection Criteria: Facility ID FA0016693 <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 OW0013534 New Owner ID <br /> Owner Name THOMPSON RANCH <br /> Owner DBA THOMPSON RANCH <br /> Owner Address 7603 S JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 7603 S JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016693 <br /> Facility Name THOMPSON RANCH <br /> Location 7603 S JACK TONE RD Z`� tu <br /> STOCKTON, CA 95215 <br /> Phone 209-943-0260 x0 <br /> Mailing Address 7603 S JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code 99 - UNINCORPORATED to Alt Phone <br /> BOS District 002- RUHSTALLER, LARRY Fax <br /> APN 18117002 Ell <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029575 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name THOMPSON RANCH (Circle One) <br /> Account Balance as of 1/31/2013: $0.00 <br /> (Circle One) <br /> Transfer to Acwonactve <br /> Program(Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> M-Farm Operations PR0524878 Active Y N A I D <br /> 222 SM HW GEN<5 TONS/YR PRO530308 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 0-AST FAC -SPCC EXEMPT PRO530306 EE0002670-MUNIAPPA NAIDU Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0532146 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 specigc,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 ca"that all operations will be performed in accordance with all applicable Ordinance Codes ander Standards and State ardor <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 Recei.e <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> K S � <br />