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Date run 9/12/2016 12:16:30PI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/12/2016 <br /> Record Selection Criteria: Facility ID FA0017329 <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 OW0014170 New Owner ID <br /> Owner Name FRANK N VILLINES <br /> Owner DBA FRANK N VILLINES <br /> Owner Address 1418 LEAH WAY 70fo 6 ti <br /> OAKDALE, CA 95361-3287 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1418 LEAH WAY o27D/P ll/ o 4 { <br /> OAKDALE, CA 95361-3287 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0017329 10186275 <br /> Facility Name FRANK N VILLINES <br /> Location 20354 SANTA FE <br /> ESCALON, CA 95361 <br /> Phone 209-845-9313 x0 <br /> Mailing Address 1418 LEAH WAY AveOAKDALE, CA 95361-3287 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 24920002 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 AR0030211 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility, / Account <br /> Account Name FRANKNVILLINES (Circle One) <br /> Account Balance as of 9/12/2016: $0.00 <br /> (Circle One) <br /> Transfer to ActiveAnacw. <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> New Omer? Delete <br /> 1958-HM-Farm Operations PRO525514 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529797 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532143 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anmor project specific,PH&EHD hourly charges associated with this facility <br /> or activity,will be billed to the party identried as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and'or Standards and State anNor <br /> Federal Lewis <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 y <br /> EHD Staff: Date /_I_ Account out: III Date / f� <br /> COMMENTS: <br /> Invoice#: <br />