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Date run 2/1312018 10:52:30AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 45021 <br /> Run by Pagel <br /> Facility Information as of 2/13/2018 <br /> Record Selection Crites: Facility ID FA0003396 <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 1 Fed Tax ID <br /> Owner ID OW0002522 Case Number: 002447 New Owner ID <br /> Owner Name BARCELOS, DALLAS <br /> Owner DBA BARCELOS, D DAIRY <br /> Owner Address 29094 LEMON AVE <br /> ESCALON, CA 95320 <br /> Home Phone 209-301-4112 <br /> Work/Business Phone 209-349-2646 <br /> Mailing Address 29094 LEMON AVE <br /> ESCALON, CA 95320 <br /> care of BARCELOS, DALLAS <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0003396 10181133 <br /> Facility Name BARCELOS, D DAIRY <br /> Location 29094 LEMON AVE <br /> ESCALON, CA 95320 <br /> Phone 209-201-4112 <br /> Mailing Address 29094 LEMON AVE <br /> ESCALON, CA 95320 <br /> Care of BARCELOS, DALLAS <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> I30S District 004-WINN, CHARLES Fax <br /> APN 24912032 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name BRASIL, RUI & JENNIFER DAIRY <br /> Title <br /> Day Phone 209-838-8598 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002973 New Account[D: _ <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility 1 Account <br /> Account Name BARCELOS, D DAIRY ((;!role One) <br /> Account Balance as of 2/13/2018: $176.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525918 EE0002670-MUNIAPPA NAIDU Active Y N A Q D <br /> 2011 -GRADE A DAIRY PR0200081 EE0005362-NICHOLAS WIESEMAN Inactive Y N A I D <br /> 2332-EXEMPT TANK FACILITY PR0234292 EE0000032-JOHN ALANIZ Active,[ Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F. PRO507333 EE0002670-MUNIAPPA NAIDU InactivE Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0530099 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0531436 Inactive Y N A I D <br /> 4620-DAIRY- WATER SUPPLY WA0515675 EE0004589-KADFANNE LINHARES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: ],the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHVEHD hourly charges associated with this facility <br /> or activity will be b bled to the party identified as the OWNER on this farm. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or standards and State andlor <br /> Federal Laws_ <br /> APPLICANT'S SIGNATURE: Date 1 I <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date ! 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 <br /> Payment Type Check Number Received by <br /> H <br /> E H D Staff: AL)Cn DateJAccount out: __j Date <br /> COMMENTS: `� c' L,Jy,) �� r � � Invoice#: <br />