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Date run 1/10/2014 3AZ30PI\ SAN JOI Run by 7777- C:onnnn1F1 Record Selection crnena. 1 OWNER FILE INFORMATION COUNTY ENVIRONMENTAL HEAL Facility Information as of 1/10/2014 Owner ID oW0000128 Owner Name Ensher, Alexander Barsoom, Inc. ENSHER, ALEXANDER & BARSOOM Owner DBA owner Address 530 BERCUT DR STE D SACRAMENTO, CA 958140101 Home Phone 916-443-6875 Work/Business Phone 916-417-8205 Mailing Address PO BOX 1044 Y N A Y N A I D Walnut Grove, CA 95690 Care of ENSHER, ALEXANDER & BARSOOM FACILITY FILE INFORMATION Facility ID / CERS ID FA0000151 10461103 Facility Name Stockton Ranch,.,, Location 14125 eali#ornia 4 Stockton, CA 95206 Phone 916-417-8205 x Mailing Address PO BOX 1044 Walnut Grove, CA 95690 Care of Jim Barsoom Location Code 99 - UNINCORPORATED P BOS District 003 - BESTOLARIDES APN 12920012 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0000150 Mail Invoices to Facility Account Name Stockton Ranch Account Balance as of 1/10/2014: $0.00 Report #5021 )EPARTMENT Pagel Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN / Fed Tax ID New Owner ID : _ Alt Phone Fax EMail : New Account ID: : Mail Invoices to: Owner / Facility / Account (Circle One) (circle one) Transfer to ActrveAnactve APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date ( / Payment Type Check Number Received �y REHS: 1 N NCa Date 1 / Lo / _ Account out: tj Date COMMENTS: g 222 2831 itA C,c-�- 0 v S AOL e, Record ID Employee ID and Name Status New Owner? Delete Program/Element and Description I D 95 HM -Farm Operations ✓ q PR0538329 PR0538328 EE0001421 - STACY RIVERA Active Active Y N A Y N A I D M HW GEN <5 TONS/YR HOUSING-SEASONAL<180 DAYS PR0270095 EE0002089 - OMRAN SOOD Inactive Y N A 1 C I 5 -EMPLOYEE 2831 AST FAC >/= 1,320 - <10 K GAL CUMULATIVE P_ PR0538330 WA0461355 EE0001421 - STACY NE ELL EE0005838 - ADRIENNE ELLSAESSER Active Inactive Y N A I Y N A I `4 TNC WATER SYSTEM (QRTLY) 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 facil in accordance with all applicable Ordinance Codes and/or Standards and Slate andl or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date ( / Payment Type Check Number Received �y REHS: 1 N NCa Date 1 / Lo / _ Account out: tj Date COMMENTS: g 222 2831 itA C,c-�- 0 v S AOL e,