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[Date"r-un 7/27/2015 11:11:49AI SAN JOAQUIN COUNTY ENVIROONMENTAL HEALTH DEPARTMENT Report#5021 <br /> un y <br /> Facility Information as of 7/27/2015 Pagel <br /> Record Selection Criteria'. Facility ID FA0016803 <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 1 Fed Tax ID <br /> Owner ID OW0013644 New Owner ID <br /> Owner Name MURPHY RANCH (WMOP) <br /> Owner DBA MURPHY RANCH (WMOP) <br /> Owner Address 0 SAN JULIAN RD <br /> FARMINGTON, CA 95230 <br /> Home Phone Not Specified <br /> Wcrk/Business Phone Not Specified <br /> Mailing Address PO BOX 15 <br /> FARMINGTON, CA 95230 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016803 10185433 <br /> Facility Name MURPHY RANCH (WMOP) <br /> Location 0 SAN JULIAN RD <br /> FARMINGTON, CA 95230 <br /> Phone 209-886-5493 x0 <br /> Mailing Address PO BOX 15 <br /> FARMINGTON, CA 95230 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 18714006 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name l` � <br /> TitleDay Phone <br /> Night Phone l� ` O <br /> ACCOUNTS RECEIVABLE FILE INFORMATION S � <br /> Account ID AR0029685 A �,� }�j C✓' � `r New Account ID. <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility f Account <br /> Account Name MURPHY RANCH (WMOP) i ` (Circle One) <br /> Account Balance as of 7127/2015: $106.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgranVElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0524988 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0530145 EE0000753-WILLY NG Inactive Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534395 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. 1,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PH5IFND hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on t -s For I also certify that all operations will be performed in accordance with all applicable Ordinance Codes ancVar Standards and State and/or <br /> Federal Laws. <br /> r <br /> APPLICANT'S SIGNATURE: 1 Date � 1 1 r S <br /> /Zz"' <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date ! ! <br /> Water System to be TRANSFERED: Amount Paid Date 1 ! <br /> Payment Type Check Number Received by <br /> EHD Staff: JV? /1/97/1 __ Date 12:�:1 1 S Account out: Date <br /> COMMENTS.. <br /> Invoice#: <br />