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D <br /> atem 1y26/2014 11:53:511 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report%5021 <br /> Facility Information as of 12/26/2014 Pagel <br /> Record Selection cmena: Facility 10 FA0017025 <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 OW0013866 New Owner ID <br /> Owner Name C&G FARMS <br /> Owner DBA C&G FARMS <br /> Owner Address 3458 W LINNE RD 1.77]_ 'y LSA <br /> TRACY, CA 95304 f5 <br /> Home Phone Not Specified CA <br /> Work/Business Phone 209-835-2412 <br /> Mailing Address 3458WLINNE RD 11'7'7 UJ• 1 Inn 1tA <br /> TRACY, CA 95304 -T cm" C A- 'YOL' <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017025 10185775 <br /> Facility Name C&G FARMS <br /> Location 17771/1/ LINNE RD <br /> TRACY, CA 95304 <br /> Phone 209-835-2412 x0 <br /> Mailing Address 3458 W LINNE RD 11� <br /> TRACY, CA 95304 <br /> Care of C & G Farms <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 23922010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title �c^ <br /> Day Phone `-'C"• c -.7C <br /> Night Phoneb2\\tS^1�?1 IVNP <br /> ACCOUNTS RECEIVABLE FILE INFORMATION S(kU -14-e 0,4i(o <br /> Account ID AR0029907 ft) <br /> ' J'`k ("O"_) D: <br /> D: <br /> Mail Invoices to Owner IO t�l J7 Lel&``v / Facility / Account <br /> Account Name C&G FARMStic\ x'10.1 ii F Ce \ <br /> C (Circle One) <br /> Account Balance as of 12/26/2014: $0.00 W ' ` n2 6ZA <br /> �' , A cis 44 <br /> cci¢le one) <br /> Transfer to Alive te <br /> Progrent m/Elemeand Description Record ID Employee ID and Name Status New OwneR Delete <br /> 1958-HM-Farm Operations PR0525210 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0529361 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0529360 EE0009001 -ELENA MANZO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534534 Inactivc Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,sclo oMedgs that all site,anNor project specific,PHSIEHD hourly charges associated with this twiny <br /> or activity will be billed to the Parry identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes an&or Standards and State andfor <br /> Federal Laws, <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / I <br /> Payment,TTYpe_ Check Number Received by <br /> REHS: c`sLYLh11M `.11aA� Date Account out: 14e2 Date I IJr lL <br /> COMMENTS: <br />