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Date run 12/26/2014 9:28:59A SAN JOIitaai;UIN COUNTY ENVIRONMENTAL HEAs.0I DEPARTMENT Report#5021 <br /> Run by Facility Information as of 12/26/2014 Papel <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 1305 EL17ABETH AVE 141 <br /> ESCALON, CA 95320-2018 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1305 ELIZABETH AVE <br /> ESCALON, CA 95320-2018 <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 xO <br /> Mailing Address 1305 ELIZABETH AVE <br /> ESCALON, CA 95320-2018 yffiLy y i¢ q '5-3 go l— _-37_X-7 <br /> Care of <br /> Location Code 99-UNINCORPORATED.4 Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 24920002 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 ARAA 11 New Account D: <br /> Mail Invoices to Q Ow <br /> ,�r Mail Invoices to: Owner / Facility / Account <br /> Account Name RANK N VILLINES (Cirde One) <br /> Account Balance as of 12126/2014: $0.00 <br /> (Cirde One) <br /> Transrerto Adive,lnadve <br /> ProgrrNElement and Description Record ID Employee ID and Name Status New 0.0 Delete <br /> 1958-HM-Farm Operations PRO525514 EE0002474-MICHAEL PARISSI Active Y N A 1 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,andor project specific,PHSrEHD hourly charges associated with this facilby <br /> cradivitywill be billetl 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 ardor <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 /> PaymentType Check Number Received by <br /> REHS: r. DateAccountout Date / / / IS <br /> COMMENTS: <br /> I Z- 30—i'U: Oe.>- lle&LA) <br />