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Report 45021 <br /> Date run 2120:2014 10:42:12AI SAN JO.�'JIN COUNTY ENVIRONMENTAL HEAT I+PARTMENT Paget <br /> Run by Facility Information as of 2/20/2014 <br /> Record Selection Criteria: Facility ID FA0017128 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID <br /> Owner ID OW0013969 New Owner ID <br /> Owner Name BATES FARMS <br /> Owner DBA BATES FARMS <br /> Owner Address 21200 N DAVIS RD <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 1227 <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0017128 10,185,937 <br /> Facility Name BATES FARMS <br /> Location 21200 N DAVIS RD <br /> LODI, CA 95240 <br /> Phone 209-649-4030 x0 <br /> Mailing Address PO BOX 1227 <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 01309033 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 AR0030010 New Account ID: <br /> Owner Mail Invoices to: Owner 1 Facili 1 Account <br /> Mail Invoices to P( <br /> Account Name BATES F N (Circle One) <br /> Account Balance as of 2/20/2014:t!51 <br /> ��/� <br /> (Circle One) <br /> Transferto Activetinactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner.) Delete <br /> 1958-HM-Farm Operations PR0525313 Active Y N A0 D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO531074 EE0000753-WILLY NG Active,I Y N A IJl D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534033 InactivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD 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 andror <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: f5� Date ! 1 <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date / ! <br /> Water System to be TRANSFERED: Amount Paid Date I ! <br /> Payment T e Check Number Receiv <br /> REHS: (1�� _ 1 Date_ 1 1�Account out: Date <br /> COMMENT 1 <br /> r2Voice� <br />