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Date rug 31/2015 11:39iWAM SAN JOA 7N COUNTY ENVIRONMENTAL HEAL' DEPARTMENT Report#5021 <br /> Run by �� 1.10V Paget <br /> Facility Information as of 3/2/2015 <br /> Record Selection Criteria: Facility ID FA0017081 <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 OW0013922 New Owner ID <br /> Owner Name EDWARD V LEONARDINI <br /> Owner DBA EDWARD V LEONARDINI <br /> Owner Address 5445 LEONARDINI RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-403-6641 <br /> Mailing Address 5445 LEONARDINI RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017081 10185865 <br /> Facility Name EDWARD V LEONARDINI <br /> Location 5445 LEONARDINI RD <br /> STOCKTON, CA 95215 <br /> Phone 209-403-6641 x <br /> Mailing Address 5445 LEONARDINI RD <br /> STOCKTON, CA 95215 <br /> care of EDWARD LEONARDINI <br /> Location Code Alt Phone <br /> BOIS District Fax <br /> APN 08705216 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 AR0029963 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name EDWARD V LEONARDINI (areae one) <br /> Account Balance as of 3/2/2015: $26.00 <br /> (Circle One) <br /> Transfer to Activeflnaclve <br /> Progrnm/Element and Description Record ID Employee ID and Name Status New Omer' Delete <br /> 1958-HM-Farm Operations PR0525266 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> AST FAC -SPCC EXEMPT PRO539721 EE0000005-FATINAH ZAREEF Active Y N A G D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531944 InactivE Y N A I D <br /> (��u <br /> 9NG <br /> and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent ofti same,acknowledge tint all site,cedar palled specific,PH&EHe hourly charges a Standards <br /> and S this facility <br /> or activity will be billed to the party identified as the OWNER on This loam. 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes andlor Slantlartls antl State cedar <br /> Federal Lewis <br /> APPLICANTS SIGNATURE: ��, '/ Date Z,/ 2-- / S <br /> a <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date—L—Jim— <br /> Payment <br /> /Payment Type Check Number Received y <br /> RENS: ✓-1 - N.Q'(®i[� Date Account out: Date <br /> COMMENTS: �D � T-" <br /> l l 3v o0--` <br /> 1 — Soho / c,G�AA- "f�tTGavnte.�.4',I <br />