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Date run 6/17/2016 12:08:42PI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 6/17/2016 <br /> Record Selection Criteria Facility ID FA0022512 <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 : 1q -36 0 1 i S-1 <br /> Owner ID OW0020034 New Owner ID : !(kLo 111i <br /> Owner Name Towne Enterprises <br /> Owner DBA <br /> el <br /> f <br /> Owner Address <br /> 7 I`517 <br /> Horne Phone Not Specified 2J14 9 6 L-32J <br /> Work/Business Phone 916-776_1424 <br /> Mailing Address PO Box 185 <br /> Walnut Grove, CA 95690 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0022512 10602454 <br /> Facility Name Towne Enterprises/New Hope Ranch i <br /> Location 13045 Lauffer Rd <br /> Thornton, CA 95686 <br /> Phone 916-776-1424 x <br /> Mailing Address PO Box 185 D, fz <br /> Walnut Grove, CA 95690 S 11,514, <br /> Care of Randy Baranek _ <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 001-030-10 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name �rG ra K <br /> Title 0 L.Jner <br /> Day Phone t 9 ey 6 c;-_. Y j l <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0041192 New Account III <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility I Account <br /> Account Name Mary LU Hutson (Circle one) <br /> Account Balance as of 6/17/2016-. $0.00 <br /> (Circle One) <br /> Transfer to Activellractve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO539377 EE0002670-MUNIAPPA NAIDU Inactive Y N A @ D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/I 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 anclor Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: L����� ° Date ! 1 J I I s� <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date / ! <br /> Water System to be TRANSFERED: Amount Paid Date 1 ! <br /> Payment Type Check Number Received <br /> EHD Staff: Date I 1 Account out: Date _! / <br /> COMMENTS: <br /> Invoice#: <br /> H sy Hv <br />