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[Record <br /> terun 1/21!2015 g:2g:00AII SAN JOAQUIN COUNTY ENVIRONMENTAL,HEALTH DEPARTMENT Report*5021 <br /> n by <br /> Facility Information as of 1/21/2015 Paget <br /> Selection Criteria: Faciiity IO FA0016931 <br /> Make changeslcorrections in RED ink. f� / /� <br /> INFORMATION CHANGE(date) ( (�/ 70 <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax JD <br /> Owner ID OW0013772 New Owner ID <br /> Owner Name MOHLER FARM <br /> Owner DBA MOHLER FARM _ <br /> Owner Address RD <br /> RIPON, CA 95366 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-541-7427 <br /> Mailing Address 1265 S MOHLER RD <br /> RIPON, CA 95366 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0016931 10185639 <br /> Facility Name MOHLER FARM <br /> Locatjon <br /> RIPON, CA 95366 <br /> Phone 209-541-7427 x <br /> Mailing Address 1265 S MOHLER RD <br /> RIPON, CA 95366 <br /> Care of Randy Mohler <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOIS District 005 - ELLIOTT, BOB Fax <br /> APN 25727076 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 AR0029813 New Account ID: _ <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility ! Account <br /> Account Name MOHLER FARM (Circle One) <br /> Account Balance as of 112112015: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlEfement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> F1958-HM-Farm Operations PRO525116 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN <5 TONS/YR PRO530325 EE0009001 -ELENA MANZO Active Y N A I D <br /> 840-AST EXEMPT FAC < 1,320 GAL PR0530324 EED002670-MUNJAPPA NAIDU Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO533470 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT,. t,"undersigned owner.operator or agent of same,acknowledge that all site,andlor project specific houry 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 andlor Standards and State andror <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 / r <br /> REHS: Date I f Account out: Date f ! <br /> COMMENTS: <br />