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Date run 11/24/2014 8:10:16A SAN JUIN COUNTY ENVIRONMENTAL HEAT—R DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/24/24 <br /> Record Selection Criteria: Facility ID FA0004501 <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 OW0003416 New Owner lD <br /> Owner Name MACHADO, MIGUELA <br /> Owner DBA ESCALON LIVESTOCK MARKET <br /> Owner Address 25525 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-595-2014 <br /> Mailing Address PO BOX 26 <br /> ESCALON, CA 95320 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0004501 10181641 <br /> Facility Name ESCALON LIVESTOCK MKT <br /> Location 25525 E LONE TREE RD <br /> P ne 209-838-7011 <br /> Mailing Address 25525 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Care of Miguel A. Machado <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005-ELLIOTT, BOB Fax <br /> APN 20732015 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004183 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ESCALON LIVESTOCK MKT (Circle One) <br /> Account Balance as of 11/24/2014: $0.00 <br /> (Circle One) <br /> Transfer to Aclivellnachie <br /> ProgranhTlement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0520209 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512563 EEo0000OO-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510275 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO535025 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532141 Inactive Y N A I D <br /> 4634-TNC WATER SYSTEM(ORTLY) WA0461344 EE0005838-ADRIENNE ELLSAESSER Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project speci ic,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 andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date /_I Account out: Date <br /> COMMENTS: <br />