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Date run 2/10/2014 9:57:42Ak SAN JO � Report#5021� IN COUNTY ENVIRONMENTAL HEAT DEPARTMENT Pagel <br /> Run1273 v Facility Information as of 2/18/2014 <br /> Record Selection Criteria: Facility ID FA0016806 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013647 New Owner ID <br /> Owner Name RIO VERDE ORCHARDS LP <br /> Owner DBA RIO VERDE ORCHARDS LP <br /> Owner Address 2404 THADDEOUS DR <br /> ESCALON, CA 953201882 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 2404 THADDEOUS DR tq <br /> ESCALON, CA 9532011 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016806 10,185,439 <br /> Facility Name RIO VERDE ORCHARDS LP <br /> Location 7303 S HENRY RD <br /> FARMINGTON, CA 95230 <br /> Phone 209-614-9263 XO <br /> Mailing Address 2404 THADDEOUS DR <br /> ESCALON, CA 953204182 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 18739004 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 AR0029688 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility 1 Account <br /> Account Name RIO VERDE ORCHARDS LP (Circle One) <br /> Account Balance as of 211812014: $53.00 <br /> (Circle One) <br /> Transfer to Activellnactva <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO524991 Active Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO529951 EE0000753-WILLY NG Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534347 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that aft site,andtor project specific,PNSlEHD 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 withal]applicable Ordinance Codes andror Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED; *$25.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: Amount Paid Date i 1 <br /> Payment Type Check Number 209 <br /> REHS: Date 1 I Account out: Date I 1 r <br /> COMMENTS: ' <br />