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Date run 2/7/2017 11:44:50AM SAN JOAQUIN COUNTY 1NVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 2/7/2017 Pagel <br /> Record Selection Criteria: Facility ID FA0017465 <br /> Make changestcorrections 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 OW0014306 New Owner ID <br /> Owner Name MACHADO DAIRY FARMS <br /> Owner DBA MACHADO DAIRY FARMS <br /> Owner Address 30000 GARDEN AVE <br /> MANTECA, CA 95337 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 30000 GARDEN AVE 70 12)Du <br /> MANTECA, CA 95337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017465 10186481 <br /> Facility Name MACHADO DAIRY FARMS <br /> Location 19405 MARIPOSA RD <br /> STOCKTON, CA 95215 <br /> Phone 209-602-3474 x0 <br /> Mailing Address 30000 GARDEN AVE �Q {7jpx NL{3D <br /> MANTECA, CA 95337 ( I GAf 532,7 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 20502002 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 AR0030347 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MACHADO DAIRY FARMS (Circle One) <br /> Account Balance as of 2/7/2017: $80.00 <br /> (Circle 0") <br /> Transferto Actwellnactre <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525650 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO529320 EE0001 421 -STACY RIVERA Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534553 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Ne undersigned owner,operator or agent of same,acknowledge that all site,andor protea specific,PHS/EHD 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 ander Standards and State ands <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 Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date --Z- / / / -7 <br /> COMMENTS: <br /> Invoice#: <br />