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I <br /> 1 <br /> Date run 4/5/2016 11:44:59AIV SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/5/2016 <br /> Record Selection Criteria: Facility ID FA0017397 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0014238 New Owner ID <br /> Owner Name FRANK BAVARO <br /> Owner DBA FRANK BAVARO <br /> Owner Address 26312 E JONES <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address .26312;—;r;NE 1-7 3 0 k c, 6e <br /> ESCALON, CA 95320 ' CC- scC- L0rJ IC Q 3a0 -91,41L4 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017397 10186391 <br /> Facility Name FRANK BAVARO <br /> Location 26312 E JONES <br /> ESCALON, CA 95320 <br /> Phone 209-838-2651 x0 <br /> Mailing Address 2,6812 <br /> I=jQ E-& <br /> ESCALON, CA 95320 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 24718007 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030279 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name FRANK BAVARO (Circle One) <br /> Account Balance as of 4/5/2016: $53.00 <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 PR0525582 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0529793 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531931 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 andror Standards and State andor <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: 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 / / Account out: � Date q I6� IL6 <br /> COMMENTS: OF <br /> Invoice#: <br /> 0.s 40 ter- t'e ��rA w%Q:, \ <br />