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LRRP <br /> ran 3/6/2014 8:42:34AM SAN J VIN COUNTY ENVIRONMENTAL HE Repel#5021 <br /> -, �DEPARTMENT vFacility Information as of 3/6/2 Paget <br /> Selection Cdtada: Facility ID FA0017497 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID OW0014338 New Owner ID <br /> Owner Name MACHADO/MACHADO DAIRY <br /> Owner DBA MACHADO/MACHADODAIRY <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 /> BOS District Fax <br /> APN 25712001 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 AR0030379 New Account ID: <br /> Mail invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MACHADO/MACHADO DAIRY (Circle One) <br /> Account Balance as of 3/6/2014: $266.00 <br /> (Circe One) <br /> Transfer to ActvelnecNe <br /> ProgmMElement and Description Record ID Employee ID erM Name Status New Omen Delete <br /> 1958-HM-Farm Operations PR0525682 Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO531028 EE0009001 -ELENA MANZO Active Y N A D <br /> 2830-AST FAC -SPCC EXEMPT PRO531027 EE0009001 -ELENA MANZO Active,l Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534734 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent or same,acknowledge that all site,andor project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. 1 also certity Nat all operations will be performed In accordance with all applicable Ordinance Codes anchor Standards and State andor <br /> Fedaral 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 Race' y <br /> REHS: Jp.V1Q�O+tst.7 Datte/�a.r�/� / Accountoutylr'. `�L' Date=/=/14 <br /> COMMENTS: k -lite A�.Q C f?v,4groQ-A1ok W lk /— <br /> �/ ( V' 1 no" 0conf-I- <br /> Q08Q4 ®k 03-e-1q . <br /> ct'q3 - io-ice r ••._ z <br />