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Date run 2126!2014 4:46:47PR SAN JOf'%/,IN COUNTY ENVIRONMENTAL HEAL %--bEPARTMENT Report A5021 <br /> Run by Pagel <br /> Facility Information as of 2/26/2014 <br /> Record Selection Criteria: Facility ID FA0017175 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner 1D OW0014016 New Owner <br /> Owner Name RICHARD BONOTTO �D(1D`� <br /> Owner DBA RIG f{,o j)_8gN f-O ,kj <br /> Owner Address 601 W CONNIE ST a1-6-711 <br /> LODI, CA 95240-3946 <br /> Home Phone Not Specified <br /> worklBusiness Phone Not Specified <br /> Mailing Address 601 CONNIE ST <br /> LODI, CA 95240-3946 <br /> Care of <br /> FACILITY FILE INFORMATION _ <br /> Facility ID I CERS ID FA0017175 10,186,019 <br /> Facility Name RICHARD BONOTTO ltir "'LZ <br /> Location 3294 W SARGENT RD <br /> LODI, CA 95242 <br /> Phone 209-368-2469 x0 <br /> Mailing Address 601 CONNIE ST 1-37q <br /> LODI, CA 95240-3946 L!4 52--'-F5' <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> SOS District 004 -VOGEL, KEN Fax <br /> APN 02514010 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 AR0030057 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility I Account <br /> Account Name RICHARD BONOTTO (Circle One) <br /> Account Balance as of 2/2612014: $53.00 <br /> (Circle One) <br /> Transferto Activellaactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1958-HM-Farm Operations PR0525360 Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529576 EE0000753-WILLY NO Active,! Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532044 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: t,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project speck,PHS+EHD hourly charges associated vnth this facility <br /> or activity will be billed to the party identified as the OWNER on this form. )also certify that all operations will be performed in accordance with all applicable Ordinance Codes andler Standards and State andlor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date ! <br /> Payment Type Check Number Reciveed by <br /> REHS: Date I I Account out: rz Date II <br /> COMMENTS: <br />