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Date run 4/11/2016 9:13:22AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 4/11/2016 <br />Record Selection Criteria: Facility ID FA0017360 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0014201 <br />Owner Name <br />RODOANI RANCH INC <br />Owner DBA <br />RODOANI RANCH INC <br />OwnerAddress <br />19909 E HWY 120 <br />ESCALON, CA 95320 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-838-2613 <br />Mailing Address <br />17750 CARROLTON RD <br />ESCALON, CA 95320-9749 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0017360 10186327 <br />Facility Name <br />RODOANI RANCH INC <br />Location <br />19909 E HWY 120 <br />ESCALON, CA 95320 <br />Phone <br />209-838-2613 x0 <br />Mailing Address 17750 CARROLTON RD <br />ESCALON, CA 95320-9749 <br />Care of Michael A. Rodoani <br />Location Code 99 - UNINCORPORATED A <br />BOS District 004 - WINN, CHARLES <br />APN 20508013 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changes/corrections in RED ink. ++ <br />INFORMATION CHANGE (date) f (� <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0030242 <br />Mail Invoices to Owner Mail Invoices to: <br />Account Name RODOANI RANCH INC <br />Account Balance as of 4/11/2016: $53.00 <br />New Account ID: : <br />Owner / Facility <br />(Circle One) <br />Account <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 PR0525545 EE0002670 - MUNIAPPA NAIDU Active Y N AD <br />2830 -AST FAC - SPCC EXEMPT PRO529606 EE0009001 - ELENA MANZO Inactive Y N A 9 D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0533516 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 andlor <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 <br />EHD Staff: M Date _/ I) /�_ Account out: Date /ZZ e <br />COMMENTS: <br />Invoice #: <br />1 / <br />