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Date run -2/21/2014 12:28:05P1 SAN JOAV%yIN COUNTY ENVIRONMENTAL HEAL". DEPARTMENT <br /> Report#5021 <br /> R,by V Pagel <br /> Facility Information as of 2/21/2014 <br /> Record Selection Crams: Facility ID FA0018154 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014897 New Owner ID <br /> Owner Name C&D FARMS <br /> Owner DBA C&D FARMS <br /> Owner Address 3761 BROOK VALLEY CIR <br /> STOCKTON, CA 95219 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 3761 BROOK VALLEY CIR <br /> STOCKTON, CA 95219 <br /> Care of <br /> FACILITY FILE INFORMATION ` <br /> Facility lD/CERS ID FA0018154 10,186,801 //Y /n1 i <br /> Facility Name C&D FARMS ^ <br /> Location 7000 W RINDGE RD <br /> STOCKTON, CA 95219 <br /> Phone 559-469-5146 x0 <br /> Mailing Address 3761 BROOK VALLEY CIR <br /> STOCKTON, CA 95219 d <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> Bos District 003 - BESTOLARIDES Fax <br /> APN 07105010 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 AR0031924 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name C&D FARMS (CircleOni <br /> Account Balance as of 2/21/2014: $53.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? D e <br /> 1958-HM-Farm Operations PRO526797 Active Y N A I <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534655 Inactive Y N A <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,Ne undersigned owner,operator or agent ofsame,aclmowledge that all site,ardor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party IdentJied as the OWNER on this form. I also call that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <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 Type Check Number Received by <br /> RENS: Date / / Account out: te Da �/ /fkl <br /> COMMENTS: <br />