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Date run 1/31/2013 2:21:14PN SAN J(OUIN COUNTY ENVIRONMENTAL HE*DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 1/31/2013 <br /> Record Selection Criteria: Facility ID FA0017108 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013949 New Owner ID <br /> Owner Name RENWICK FARM <br /> Owner DBA RENWICK FARM <br /> Owner Address 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified �t / <br /> Mailing Address 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 IY <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017108 <br /> Facility Name RENWICK FARM <br /> Location 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Phone 209-484-6678 x0 <br /> Mailing Address 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> Location Code Alt Phone <br /> BOB District Fax <br /> APN 06311020 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 AR0029990 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name RENWICK FARM (Circle One) <br /> Account Balance as of 1/31/2013: $0.00 <br /> (Circe One) <br /> Transfer to Activellnaclve <br /> Progra"Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> HM-Farm Operations PR0525293 Active Y N A 1 D <br /> 2220-SM HW GEN<5 TONS/YR PR0530391 J EE0001422-ARTS CACAPIT Active Y N A D <br /> -AST EXEMPT FAC < 1,320 GAL PRO530390 EE0001422-ARTS CACAPIT Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0533583 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operator or agent ofsame,acknowledge that all site,ander protect specific,PHS/EHD hourly charges associated with thisfacility <br /> or activity will be billed to the party identified as the OWNER on this form I also certify that all operations will be perfomed in accordance with all applicable Ordnance Codes and'or Standards and State and'or <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 b <br /> REHS: rril �fif 0 Date�l�_l Account out: Date 14 l l 3 <br /> COMMENTS: �r <br /> v ZY(.� 13�13 <br />