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Date run 5/12/2017 8:53:23AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 5/12/2017 <br />Record Selection Criteria: Facility ID FA0020343 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID <br />OW0016701 <br />Owner Name <br />DARYL MORET <br />Owner DBA <br />DARYL MORET <br />Owner Address <br />714 HAWES LANE <br />RIPON, CA 95366 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />714 HAWES <br />RIPON, CA 95366 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0020343 10482217 <br />Facility Name DARYL MORET <br />Location 12870 E HWY 120 <br />MANTECA, CA 95336 <br />Phone 209-531-4778 x0 <br />Mailing Address 714 HAWES <br />RIPON, CA 95366 <br />Care of <br />Location Code <br />BOS District <br />APN 22804005 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0036330 <br />Mail Invoices to Owner <br />Account Name DARYL MORET <br />Account Balance as of 5/12/2017: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail: <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1958 - HM -Farm Operations PR0535228 EE0002670 - MUNIAPPA NAIDU Active Y N A C11 ) D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0535298 Inactive Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD 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 and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 Received by <br />EHD Staff: Date / Z/ Account out: Date 5/ <br />COMMENTS: 1 / /Invoice #: <br />