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Date run 3111/2014 8:0&50An SAN'JO JIN COUNTY ENVIRONMENTAL HEAT. DEPARTMENT Report#5021 <br /> Run by NOW Pagel <br /> Facility Information as of 3/1112014 <br /> Record Selection Criteria: Facility ID FA0016997 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) - <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSKI Fed Tax ID <br /> Owner ID OW0013838 New Owner ID <br /> Owner Name CLfF-F-E)Ra LAUCHLAND RANCH k�k �ii^r F1ANri'-J ry - <br /> Owner DBA C-OF 'C"RD LAUCHLAND RANCH " <br /> Owner Address 5271 W TURNER RD <br /> LODI, CA 95242 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 5271 W. TURNER ST <br /> LODI, CA 95242 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0016997 10185733 <br /> Facility Name C tF LGR1D LAUCHLAND RANCH <br /> Location 5271 W'TURNER RD <br /> LODI, CA 95242 <br /> Phone 209-368-1659 x0 <br /> Mailing Address 5271 W. TURNER ST <br /> LODI, CA 95242 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 01116017 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone St <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029879 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility / Account <br /> Account Name CLIFFORD LAUCHLAND RANCH (Circle One) <br /> Account Balance as of 3/111/2014 $0.00 <br /> (Circe One) <br /> Transfer to ActivellnacNe <br /> PrograrnlEiement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525182 Active Y N A I D <br /> 2$30-AST FAC -SPCC EXEMPT PRO530448 EE0001422-ARIS CACAPIT Active,! Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531982 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT- I,the undersigned owner,operator or agent of some,acknowledge that all site,and or project specific,PHS+EHD hourly charges associated with this facility or <br /> be billed to the party identified as the OWNER on this form. i also certify that all operations will be performed in accordance with ail applicable Ordinance Codes and'or Standards and State andror 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 Recely <br /> RENS: Date 1 ✓� l Account out Date ! ! <br /> COMMENTS. <br />