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Date nm 2/11/2014 9:06:22AN SAN Jhr/UIN COUNTY ENVIRONMENTAL HEAL•.##`DEPARTMENT Report#5021 <br /> Run by 1273 Pagel <br /> Facility Information as of 2/11/2014 <br /> Record Selection Criteria: Facility ID FA0017329 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014170 New Owner ID <br /> Owner Name FRANK N VILLINES <br /> Owner DBA FRANK N VILLINES <br /> Owner Address 9805 BLACK OAK <br /> OAKDALE, CA 95361 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 9805 BLACK OAK [ <br /> OAKDALE, CA 95361 �S <br /> Care of <br /> 1 <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS 10 FA0017329 10,186,275 <br /> Facility Name FRANK N VILLINES <br /> Location 20354 SANTA FE <br /> ESCALON, CA 95361 <br /> Phone 209-845-9313 XO <br /> Mailing Address 9805 BLACK OAK F_1_1 Z aT AAE <br /> OAKDALE, CA 95361 F—AaA yzy r /1,0 <br /> Care of <br /> Location Code 99- UNINCORPORATED,4 Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 24920002 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030211 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility I Account <br /> Account Name FRANK N VILLINES (CircreOne) <br /> Account Balance as of 211112014: $53.00 <br /> (Circle One) <br /> Transferto Activellnactve <br /> ProgranVElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525514 Active Y 'N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0529797 EE0000753-WILLY NG Acfive,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532143 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: t,the undersigned owner,operator or agent of same,acknowledge that all site,and+or project specific,PHSrEHD 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 andvor Standards and State ansor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Laid Date 1 1 <br /> Payment Type Check Number Rec iv ) <br /> REHS: Date / 1 Account out: Date_ 0?_ / /.A/ r <br /> COMMENTS: ti <br />