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Date run 3/14/2011 9:36:38AR SAN JOANfIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report a5021 <br /> Run by 5290 ePagel <br /> rr Facility Information as of 3/14/2011f <br /> Record Selection Criteria: Fadlity ID FA0017561 <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 OW0014402 New Owner ID <br /> Owner Name MOHR-FRY RANCHES <br /> Owner DBA MOHR FRY RANCHES <br /> Owner Address 12609 N WEST LN <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> WorkBusiness Phone Not Specified <br /> Mailing Address 12609 N WEST LN <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017561 <br /> Facility Name MOHR-FRY RANCHES <br /> Location 10618 N HWY 88 <br /> STOCKTON, CA 95212 <br /> Phone 209-334-3808 x0 <br /> Mailing Address 12609 N WEST LNtil� L_ <br /> LODI, CA 95240 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 06312011 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 AR0030443 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MOHR-FRYRANCHES (CirdeOne) <br /> Account Balance as of 3/14/2011: $0.00 <br /> (Circle Oce) <br /> Transfer to AdNellrtaclre <br /> ProgramiElement and Descnptbn Record ID Employee 10 and Name Status New Owner? Delete <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525746 Inactive Y N AD <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529648 EE0000753-WILLY NG Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0533430 Inactive Y N Al, `-1 D <br /> 81LLING and COMPLIANCE ACKNOWLEDGEMENTI,the undersigned owner,operator"aged of same,acl lowledge that all ads.and/or project specific.PHSIEHD hourly charges associated with We <br /> facility or activity will be bored to the party Identified as the OWNER on ass form. I also certify that all operations will be performed N socordsnce with all applicable Ordinace Codes and/or Standards and <br /> Slate andtor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receiv <br /> REHS: Date / / Account out: <br /> COMMENTS: <br /> \\eh-envlenvisionireportst5021.rpt <br />