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Date run 2/11/2014 9:06:22AttReport X5021 <br /> SAN JO�UIN COUNTY ENVIRONMENTAL HEA� DEPARTMENT Pawl <br /> In, 1273 r Facility Information as of 2/11/2014 <br /> Record Selection Criteria: Facility ID FA0017329 <br /> Make changes/corrections In RED ink. <br /> INFORMATION CHANGE(dale) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION 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 9805 BLACK OAK ETtf I/ <br /> OAKDALE, CA 95361 F {-0N A1A Q.`i '{o?B —�ftAl f1 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 9805 BLACK OAK L 3f.'S 617,A3ETH E <br /> OAKDALE, CA 95361 trill �i3 o70(S' <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017329 10,186,275 <br /> Facility Name FRANK N VILLINES <br /> Location 20354 SANTA FE <br /> ESCALON, CA 95361 <br /> Phone 209-845-9313 x0 <br /> Mailing Address 9805 BLACK OAK �! l Z f3'ii I � _ <br /> OAKDALE, CA 95361 SCAL f7N , —A'y J <br /> Care of <br /> Location Code 99 _ UNINCORPORATED P 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 AR0030211 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name FRANK N VILLINES (cirdeOne) <br /> Account Balance as of 2/11/2014: $53.00 <br /> (Cirde One) <br /> Transfer to Aclivednactve <br /> Program/Element and Description Record ID Employee ID and Nam Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525514 Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0529797 EE0000753-WILLY NG Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532143 Inactivf 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,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on Nis form. I also certify 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 Recpvl <br /> REHS: Date_/ / Account out: Date <br /> COMMENTS: PQ ' A / o <br />