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Date run 2/26/2014 4:46:47Pn SAN JOIN COUNTY ENVIRONMENTAL HEALea/DEPARTMENT Report <br /> �#5021 <br /> Run by <br /> Facility Information as of 2/26/2014 <br /> Record Selection Criteria: Facility ID FA0017175 <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 OW0014016 New Owner I : <br /> Owner Name RICHARD BONOTTO 0/1D ( CCJ <br /> Owner DBA R4G++AdR4)4jG+JfffTO <br /> Owner Address 601 W CONNIE ST <br /> LODI, CA 95240-3946 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 601 CONNIE ST <br /> LODI, CA 95240-3946 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017175 10,186,019 <br /> Facility Name RICHARD BONOTTO �jltJ� <br /> Location 3294 W SARGENT RD <br /> LODI, CA 95242 <br /> Phone 209-368-2469 x0 <br /> Mailing Address 601 CONNIE ST D <br /> LODI, CA 95240-3946 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 02514010 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 AR0030057 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name RICHARD BONOTTO (Circle Chat) <br /> Account Balance as of 2/26/2014: $53.00 <br /> (Circle One) <br /> Traniferto Activellitactve <br /> Program/ lement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Fane Operations PRO525360 Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529576 EE0000753-WILLY NG Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532044 Inactiv< Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acimowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity,will be billed to Me Party identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anNor Standards and State and'or <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 Rej iv�jd by <br /> REHS: Date / / Account out: Vl'.J Date rJ Jia ILLI <br /> COMMENTS: <br />