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Date run 10/24/2017 2:42:21P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report N5021 <br /> Run by Pagel <br /> Facility Information as of 10/24/2017 <br /> Record Selection Criteria: Facility ID FA0017506 <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 OW0014347 New Owner 10 <br /> Owner Name LAGER RANCHES INC <br /> Owner DBA LAGER RANCHES INC <br /> Owner Address 16161 S MURPHY RD <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-982-5618 <br /> Mailing Address 1 0t6t-5-10trRPhy-R4) -9, C1 <br /> ESQ4rL- I5 20 0 r A Ct — pD <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0017506 10186557 <br /> Facility Name LAGER RANCHES INC <br /> Location 16161 S MURPHY RD <br /> ESCALON, CA 95320 <br /> Phone 209-993-0872 x0 <br /> Mailing Address 16161 S MURPHY RD <br /> ESCALON, CA 95320 <br /> Care of Lagier Ranches, Inc <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 20311022 Eli <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030388 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name LAGER RANCHES INC (Circle One) <br /> Account Balance as of 10/24/2017: $96.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525691 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0530221 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534311 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,shelter project specific.Pi hourly charges associated with this facility or i <br /> be billed to the party identified as the OWNER on this form Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes and'or Standards and State and/or 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: r— Date IrZ/ ;I�i <br /> COMMENTS: v <br /> - r1 c.� Invoice#: 1 <br /> ACK:'lvrJ J c�r�riC ri�JS Gh4e.+s+a� as Iyer rei I-V\, yv,cz, ` - <br />