Laserfiche WebLink
Datenrn 2/9/2015 11:54:40AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Region#5021 <br /> Run by <br /> Facility Information as of 2/9/2015 Pagel <br /> Record Selection Criteria: Faullty IID FA0005283 <br /> Make changesicorrections 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 OW0004139 New Owner ID <br /> Owner Name Julia Heckenlaible <br /> Owner DBA HECKENLAIBLE FARMS INC <br /> Owner Address 14117 N LOCUST TREE RD <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-993-0820 <br /> Mailing Address 14117 North Locust Tree Road <br /> Lodi, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0005283 10181787 <br /> Facility Name ERNESTtiEKE-#b4tBti^ PG ?hI&%bLk, <br /> Location 14117 N LOCUST TREE RD <br /> LODI, CA 95240 <br /> Phone 209-993-0819 x <br /> Mailing Address 14117 North Locust Tree Road <br /> Lodi, CA 95240 <br /> care of Dwayne Heckenlaible <br /> Location Code 99 - UNINCORPORATED A Ah Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 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 AR0005744 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name Julia Heckenlaible (circle one) <br /> Account Balance as of 2/9/2015: $292.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record 10 Employee ID and Name Status New Owner? Delete <br /> 1958.HM-Farm Operations PR0525804 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0629482 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2333-FARM UST#1 FACILITY-obsolete PR0501961 EE0000451 -STEVE SASSON Inactivt Y N A 1 D <br /> 2830-AST FAC -SPCC EXEMPT PR0529481 EE0001422-ARIS VELOSO Active Y N A 1 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0631745 Inactivc Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anoor project specific.PHS'EHD hourly Charges associated win this facility <br /> or activity,will to,billetl 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 anaor Standards and state snow <br /> Federal Laws, <br /> APPLICANTS SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment�'_pe Chedc Number Receive y <br /> REHS: HC�1�IrP.�.- Date_/ �1 / _ Account out Date /�J .$— <br /> COMMENTS: <br /> Nc�vrie. �c,tl e.� t n cuYrer✓�t y <br />