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iSAN JO. AN COUNTY ENVIRONMENTAL HEAI 'DEPARTMENT Report#5021 <br /> Date run 2/13/2015 10:14:33AI / • / Paget <br /> Run by Facility Information as of 2/13/2015 <br /> Record Selection CriteriaFacility ID FA0017089 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) 1 ` J <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0013930 New Owner ID <br /> Owner Name RUSSELL AOYAMA FARMS <br /> Owner DBA RUSSELL AOYAMA FARMS <br /> Owner Address 7505 N ALPINE RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-639-6948 <br /> Mailing Address PO BOX 766 <br /> LINDEN, CA 95236 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017089 10185881 <br /> Facility Name RUSSELL AOYAMA FARMS <br /> Location 7505 N ALPINE RD <br /> STOCKTON, CA 95215 <br /> Phone 209-639-6948 x <br /> Mailing Address PO BOX 766 <br /> LINDEN, CA 95236 <br /> care of Russell Aoyama <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 08718329 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone / <br /> ACCOUNTS RECEIVABLE FILE INFORMATION - <br /> Account ID AR0029971 �2� New Account ID: <br /> Mail Invoices to Account u Mail Invoices to: Owner / Facility / Account <br /> Account Name RUSSELL AOYAMA-F /S y (Circle one) <br /> Account Balance as of 2/13/2015: $79.00 \ <br /> (Circle One) <br /> Transfer to Active/Incite <br /> ProgransElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525274 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0528970 EE0000005-FATINAH ZAREEF Active Y N D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533155 Inactivc Y N I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT' I,the undersigned owner,operetoror agent of same,acknowledge that all site,ander project speaic,PHSEHD 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 anwor Standards and State andfor <br /> Federat Laws. <br /> APPLICANTS SIGNATURE: %%C Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date I / <br /> Water System to be TRANSFERED: Amount Paid Date I / <br /> Payment Type Check Number Receiv <br /> REHS: 77V7Date !7G/ f 3/ 1_4 Account out: Date Z/ <br /> COMMENTS: <br /> �4, As 1 <br />