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1 <br />Date run 2/8/2017 9:11:07AM <br />Run by <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Facility Information as of 2/8/2017 <br />Report #5021 <br />Pagel <br />I Record Selection Criteria: Facility ID FA0017087 I <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0013928 <br />Owner Name <br />G. CAFFESE FARMS <br />Owner DBA <br />G. CAFFESE FARMS <br />Owner Address <br />1060 S WALKER LN <br />STOCKTON, CA 95215 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />1 LN <br />ST 15 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0017087 10185877 <br />Facility Name G CAFFESE FARMS <br />Location 6102 E HWY 26 <br />STOCKTON, CA 95215 <br />Phone 209-944-0175 x0 <br />Mailing Address LN <br />5 <br />Care of <br />Location Code 99 - UNINCORPORATED P <br />Bos District 004 - WINN, CHARLES <br />APN 10125008 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0029969 <br />Mail Invoices to rAc-c.0 kr�" <br />Account Name G. CAFFESE FARMS <br />Account Balance as of 2/8/2017: $80.00 <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 />C1d61 N� [Jt- <br />�1 d6 l NG s S�r/J o nr <br />Alt Phone <br />Fax <br />EMail : <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Accou <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 PR0525272 EE0002670 - MUNIAPPA NAIDU Active Y N A I D <br />2830 - AST FAC - SPCC EXEMPT PR0530278 EE0000027 - CINDY VO Inactive Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0531708 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 />Program Records to be TRANSFERED: " $25.00 = <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: Date <br />COMMENTS: <br />Date / !, <br />Amount Paid Date ! / <br />Amount Paid Date <br />Received by <br />Account out: Date <br />* 0 CfLA \ WO.Sre io Dr - <br />Invoice #: <br />,-6.�„ to; <br />O s w� �'k-u- 1. ✓� <br />CLS �cT 1`GA u f h "\ . <br />