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Date run 2/20/2015 9:16:26AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/20/2015 <br /> Record Selection Criteria: Facility ID FA0016848 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0013689 New Owner ID <br /> Owner Name JOE SPANO <br /> Owner DBA JOE SPANO <br /> Owner Address 5950 E HARNEY LN <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-368-3391 <br /> Mailing Address 5950 E HARNEY LN <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016848 10185503 <br /> Facility Name JOE SPANO <br /> Location 5950 E HARNEY LN <br /> LODI, CA 95240 <br /> Phone 209-368-3391 x0 <br /> Mailing Address 5950 E HARNEY LN <br /> LODI, CA 95240 <br /> Care of Joe Spano <br /> Location Code 99_ UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 06106016 Eli <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name / <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION 3'O �]: l�J:7C�/�(t.f (h <br /> Account ID AR0029730 New Account ID: <br /> Mail Invoices to Account1,011% I n6c Mail invoices to: Owner / Facility / Account TAL111114S. <br /> Account Name JOE SPANO J�'� (ClrcleOne) <br /> Account Balance as of 2/20/2015: $26.00 +�J <br /> (Circle one) <br /> Transfer to Active/Inactve. <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525033 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO529275 EE0001422-ARIS VELOSO Active Y N A ( I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532783 Inactiv( Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or 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 andfor Standards and Slate 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 Ty e Check Number Received by _ <br /> RENS: V Date I / j Account out: �. /� Date �—t Z'�l 5 <br /> COMMENTS: <br />