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Data run 3/6/2014 8:42:34AM SAN JO, JIN COUNTY ENVIRONMENTAL HEAT /DEPARTMENT Report#5021 <br /> RW..vy <br /> %es, Facility Information as of 3/6/201414 <br /> Page, <br /> Record Selection Criteria: Facility ID FA0017497 <br /> Make changes/corrections In RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID <br /> Owner ID OW0014338 New Owner ID <br /> Owner Name MACHADOWACHADO DAIRY <br /> Owner DBA MACHADO/MACHADO DAIRY <br /> Owner Address 26230 S UNION RD <br /> MANTECA, CA 95337 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 26230 S UNION RD <br /> MANTECA, CA 95337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017497 10,186,539 <br /> Facility Name MACHADO/MACHADODAIRY <br /> Location 6524 PERRIN RD <br /> MANTECA, CA 95337 <br /> Phone 209-239-4164 x0 <br /> Mailing Address 26230 S UNION RD <br /> MANTECA, CA 95337 <br /> Care of <br /> Location Code Alt Phone <br /> SOS District Fax <br /> APN 25712001 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 AR0030379 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MACH /M HADO DAIRY (Circle One) <br /> Account Balance as of 3/6/2014: <br /> (Circle One) <br /> Transfer Activellnsclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525682 Active Y N AI D <br /> 2220-SM HW GEN<5 TONSNR PRO531028 EE0009001 -ELENA MANZO Active Y N A D <br /> 2830-AST FAC -SPCC EXEMPT PR0531027 EE0009001 -ELENA MANZO Active,I Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534734 Inactive Y N A I D <br /> BILLING end COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner.operator or agent a same,acknowledge hat all site,andror project spec,PHSIEHD hourly charges associated with this facility <br /> or acbWy will ba 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 ardtor <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 Check Number y <br /> REHS: VQ LL7 Date / Account out: R <br /> Date <br /> COMMENTS' /��pa <br /> Air- -HA 4e pk-,CKtiLTJ <br /> IQ Irrveron-Lok W v4-'- pCo)Or0CV0R l— <br /> Q08orI MQCJAa.dD mk <br /> Ll(- -Po lyga6tvaR 00i <br /> Ill— o, C101 <br />