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Date run 7/30/2014 2:37:42PA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/30/2014 <br /> Record Selection Criteria: Facility ID FA0017032 <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 OW0013873 New Owner ID <br /> Owner Name LARRY PELLEGRI FARMS <br /> Owner DBA LARRY PELLEGRI FARMS <br /> Owner Address 1710 HILLSIDE RD <br /> SANTA BARBARA, CA 93101-4020 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1710 HILLSIDE RD <br /> SANTA BARBARA, CA 93101-4020 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017032 10185787 <br /> Facility Name LARRY PELLEGRI FARMS <br /> Location 6588 W JACOBS RD <br /> STOCKTON, CA 95206 <br /> Phone 209-463-7079 <br /> Mailing Address 1710 HILLSIDE RD <br /> SANTA BARBARA, CA 93101-4020 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 13124004 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 AR0029914 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name LARRY PELLEGRI FARMS (Circle One) <br /> Account Balance as of 7/30/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525217 Active Y N AI D <br /> 2220-SM HW GEN<5 TONS/YR PRO530935 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0530934 EE0001421 -STACY RIVERA Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532020 Inactive 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 and/or 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 NumberRecel <br /> REHS: Date / �/ Account out: <br /> COMMENTS: elf ��_ �'�— Com// 4z' <br /> C'7_9 C-4- <br />