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Report#5021 <br /> D,W.n 2/19/2014 10:22:40AI SAN JOAN COUNTY ENVIRONMENTAL HEAy'DEPARTMENT Pagel <br /> Run by Facility Information as of 2/19/2014 <br /> Record Selection Criteria: Fedliy ID FA0016987 <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 OW0013828 New Owner ID <br /> owner Name ,J DELCARLO FARMS <br /> owner DBA J DELCARLO FARMS <br /> owner Address 835 W MARIPOSA AVE <br /> STOCKTON, CA 95204 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 835 W MARIPOSA AVE <br /> STOCKTON, CA 95204 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0016987 10,185,719 <br /> Facility Name ,J DELCARLO FARMS <br /> Location 11751 SWING LEVEE RD <br /> STOCKTON, CA 95206 <br /> Phone 209-467-3196 x0 <br /> Mailing Address 835 W MARIPOSA AVE <br /> STOCKTON, CA 95204 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 003 - BESTOLARIDES Fax <br /> APN 18921006 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account lD AR0029869 ,/ New Account ID: <br /> Mail Invoices to Owrner �D Mail Invoices to: Owner / Facility / Account <br /> Account Name J DELL RMS J (Circle One) <br /> Account Balance as of 2/19/2014 <br /> (Circle One) <br /> Transfer to AcUve/InacNe <br /> Program/Element and Description Record ID Employ.ID and Name Status New Owsre/i Delete <br /> 1958-HM-Farm Operations PRO525172 Active Y N A 12"D <br /> 2220-SM HW GEN<5 TONS/YR PR0530886 EE0002646-THUY TRAN Active Y N A <br /> 2830-AST FAC -SPCC EXEMPT PR0530885 EE0002646-THUY TRAN Active,l Y N A y D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531772 Inactive Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operator or agent of same,acknowledge that all site,anotor project specRc,PHSrEHD hourly Merges associated with thisfacility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify Mat ell operations will be performed in accordance with all applicable Ordinance Codes andior Standards and State a d or <br /> Federal Laws. �. � 11�I <br /> APPLICANTS SIGNATURE: —pI eAsp gV I sem-- Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> PaymentT Check Number Recei <br /> REHS: X I N ��INS! Date / / Account out: Date / / <br /> COMMENTS: <br /> l/01 <br />