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Date mn 12126/2014 11:53:511 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#W21 <br /> Run by Papel <br /> Facility Information as of 12/26/2014 <br /> Record Selection Criteria: Facility ID FA0017025 <br /> Make changes(comactions 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 OW0013866 New Owner lD <br /> Owner Name C&G FARMS <br /> Owner DBA C&G FARMS <br /> Owner Address 3458 W LINNE RD I "17"1 W . LLnr>e— <br /> TRACY, CA 95304 <br /> Home Phone Not Specified S <br /> Work/Business Phone 209-835-2412 <br /> Mailing Address 3458 W LINNE RD l L�• L..I nn� 1� <br /> TRACY, CA 95304 7(2 u C`,/4 GJ30LI <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017025 10185775 <br /> Facility Name C&G FARMS <br /> Location 1777 W LINNE RD <br /> TRACY, CA 95304 <br /> Phone 209-835-2412 x0 <br /> Mailing Address 3458 W LINNE RD M-7 <br /> TRACY, CA 95304 '�� Ch gci�D� <br /> Care of C & G Farms <br /> Location Code 99-UNINCORPORATED P Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 23922010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title s2cn <br /> Day Phone <br /> Night Phone �Z\\t-S'1�71 / <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029907 MJ�L� r"e")-. D: <br /> Mail Invoices to Owner JoL, -t.t� cgv&�Lw / Facility / Account <br /> Account Name C&G FARMS SQ-N& ->- (e, (GrdeCne) <br /> Account Balance as of 12/26/2014: $0.001-1--)-I W - L; ne 9-A <br /> -n a.;, , CA q5 04 <br /> (circle One) <br /> Transfer to Active/InacNe <br /> Progtanv Elemerd and Description Record ID Employee ID and Name Status New Owner/ Delete <br /> 1958-HM-Farm Operations PRO525210 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0529361 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO529360 EE0009001 -ELENA MANZO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534534 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acW.o ledge that all site,and'or project spachc,PHSIEHD 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 andor Standards and State ander <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 c -Type _Check Number Received by <br /> ct /G <br /> REHS: t �J.eARa Date t'a- /�/� Account out: � Date / / S <br /> COMMENTS: 'T•� <br />