Laserfiche WebLink
Da;�n2/9/2015 11:54:40AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> RuPagel <br /> Facility Information as of 2/9/2015Retion Criteria: Facility ID FA0005283 <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 lD OW0004139 New Owner ID <br /> Owner Name Julia Heckenlaible <br /> Owner DBA HECKENLAIBLE FARMS INC <br /> Owner Address 14117 N LOCUST TREE RD <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-993-0820 <br /> Mailing Address 14117 North Locust Tree Road <br /> Lodi, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0005283 10181787 <br /> Facility Name ERNESTHE44ENtAfBtE— P_C 1PWT%kAk, <br /> Location 14117 N LOCUST TREE RD <br /> LODI, CA 95240 <br /> Phone 209-993-0819 x <br /> Mailing Address 14117 North Locust Tree Road <br /> Lodi, CA 95240 <br /> Care of Dwayne Heckenlaible <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005744 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name Julia Heckenlaible (CirdeOne) <br /> Account Balance as of 2/9/2015: $292.00 <br /> (Circle One) <br /> Theater W Activellnadve <br /> PrograrivElement and Description Record ID Employee ID and Name Status New Owner'! Delete <br /> 1958-HM-Farm Operations PRO625804 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0529482 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2333-FARM UST#1 FACILITY-obsolete PR0501961 EE000D451 -STEVE SASSON Inactive Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0529481 EE0001422-ARIS VELOSO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531745 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Ne undersigned owner,operator or agent or same,acknowledge that all site,andfor project speck.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 candy that all operations will W pa formed in accordance with all applicable Ordinance Coates anal Standards and State anaor <br /> Federal taws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00 is Amount Paid Date I I <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Check Check Number Receive y <br /> REHS: Date_! q /_jamAccount out: Date /�/ ..$f <br /> COMMENTS: <br /> Ncw u, ille� hcavra4l y <br />