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RepoM1#5021 <br /> ERecoMselection <br /> 13/2017 11:2718/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel <br /> Facility Information as of 12/13/2017 <br /> riteria: Facility ID FA0017298 <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 OW0014139 New Owner ID <br /> owner Name BILL MARTIN P � r i <br /> Owner DBA BILL MARTIN c 1 I I " P 1 �-' <br /> Owner Address 29411 E LEMON <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> WorklBusiness Phone 209-838-2131 <br /> Mailing Address 29411 E LEMON <br /> ESCALON, CA 95320 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017298 10186235 <br /> Facility Name BILL MARTIN +t . <br /> Location 29411 E LEMON <br /> ESCALON, CA 95320 <br /> Phone 209-838-2131 x0 <br /> Mailing Address 29411 E LEMON <br /> ESCALON, CA 95320 <br /> Care of Bill Martin ` .1 M`r� <br /> Location Code <br /> Alt Phone <br /> BOS District Fax <br /> APN 24912012 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New Account ID: <br /> Account ID AR0030180 <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> (Circe One) <br /> Account Name BILL MARTIN <br /> Account Balance as of 12/13/2017: $96.00 (Circle One) <br /> Transferto Active/macive <br /> Program/Element and Description Record ID Employee ID and Name <br /> Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525483 EE0002670-MUNIAPPA NAIDU ctiv ve Y N A �D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0530098 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532107 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of some,acknowledge that all site,andror project specific.PH&EHD hourly charges associated with this facility <br /> or activity will COMPLIANCE <br /> to the party identified as the OWNER on this fortrt I also certgy that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards antl State ander <br /> Fede awa <br /> .�' I�•b r, � r / ! .e�n n `���� Date ��/ l L� /-17 <br /> PPLICAN SIGNATURE: J,4 r� <br /> Program Recerds to be TRANSFERED: '$25.00= Amount Paid Date_/_/_ <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Check Number Received b <br /> Payment Type Date /�/ <br /> EHD Staff: Date / / Account out: <br /> COMMENTS: Invoice* <br /> Add ori r�5 � <br /> )Jar /N Vee— Z// `-'/l 7 <br />