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f _ <br /> Date run 8/18/2016 2:03:1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5G21 <br /> Run by Pagel <br /> Facility Information as of 8/18/2016 <br /> Record Selection Criteria: Facility ID FA0023327 <br /> .I <br /> Make changeslcorrections in RED ink. <br /> 'INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN I Fed Tax ID <br /> Owner ID OW0021549 New Owner ID ! <br /> Owner Name E & J GALLO WINERY <br /> Owner DBA GALLO VINEYARDS INC <br /> Owner Address 28750 N SOWELS RD <br /> GALT, CA 95632 <br /> Home Phone Not Specified <br /> WorklBusiness Phone 209-613-8927 <br /> Mailing Address PO BOX 1130 <br /> MODESTO, CA 95353 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0023327 10631008 i <br /> Facility Name Gallo Vineyards, Inc. <br /> Location 28750 N SOWLES <br /> GALT, CA 95632 <br /> Phone 209-744-1142 x <br /> Mailing Address 28750 N SOWELS ROAD <br /> GALT, CA 95632 <br /> Care of GALLO VINEYARDS, INC. <br /> Location Code 99 - UNINCORPORATED A Alt Phone. <br /> BOS District 004 -WINN, CHARLES Fax <br /> Ali Eli <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GALLO VINEYARDS, INC. <br /> Title <br /> Day Phone 209-744-1142 I <br /> Night Phone 209-604-7992 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0042948 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner ! Facility 1 Account <br /> Account Name PARM DHALIWAL (Circle One) <br /> Account Balance as of 8/18/2016: $0.00 <br /> (Circle One) <br /> 4 ' 1 Transfer to Activeflnactve <br /> 6Fyement and Description Record ID Employee ID and Name !�1/1 1 i1 L4 Status New Owner? Delete <br /> J.931�,J HMBP-Reqular-Primary Location PRO540805 EE0008709- tE-LiMhai�t/�1(,� Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT, 1,the undersigned owner,operator or agent of same,acknowledge that all site,ancilor project Si PHSlEHD hourly charges associated with this facility <br /> or activity will be billed 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 andlor Standards and State ancyor <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date / 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date ! 1 <br /> Payment Type Check Number Received b <br /> EH Staff: ,M-CJ__ Date 1 1�_ Account out: bate 7l la <br /> COMMENTS: <br /> Invoice#: <br /> S ► S CA 1ll--ti�i,/!,'~� o <br />