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r <br /> Date run 3/10/2016 10:50:30AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Pagel <br /> Run by <br /> Facility Information as of 3/10/2016 <br /> Record Selection Criteria: Facility ID FA0016966 <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 OW0013807 New Owner ID <br /> Owner Name WAYNE &CAROL BRUNS <br /> Owner DBA WAYNE & CAROL BRUNS <br /> Owner Address 15322 E HWY 120 <br /> RIPON, CA 95366 <br /> Home Phone Not Specified <br /> Work(Business Phone 209-456-6249 <br /> Mailing Address X26 <br /> RIP9Po-OA�J5366 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016966 10185693 <br /> Facility Name WAYNE & CAROL BRUNS <br /> Location 18585 E MELLO AVE <br /> RIPON, CA 95366 <br /> Phone 209-456-6249 x �^ 1 <br /> Mailing Address 13322-E,-'rv: L' S�J /"`e-� PrAO <br /> care of Wayne Bruns <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 24513020 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 AR0029848 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name WAYNE & CAROL BRUNS (Circle One) <br /> Account Balance as of 3/10/2016: $0.00 <br /> (Circle One) <br /> Transfer to AcgveflnacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525151 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529944 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533800 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSrEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this fcm I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Stateend« <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 /> EHD Staff: Date_/_/_ Account out: 2&fe Date_3—_/ 1`0411 <br /> COMMENTS: Invoice#: <br />