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E <br /> 2117/2015 11:49:30AI SAN JO UIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT <br /> ,�- Report 315021 <br /> Facility Infarmatian as of 2117/206 Page'ection Criteria: Facility Ip Fp0017131 <br /> Make changes/corrections In RED ink. <br /> INFORMATION CHANGE(date) { <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID OW0013972 New Owner ID <br /> Owner Name EHLERS FAMILY FARMS <br /> Owner DBA EHLERS FAMILY FARMS <br /> Owner Address 530 S MILLS AVE <br /> LODI, CA 95242 <br /> Home Phone Not Specified <br /> Work/Business Phone 209_334_5911 <br /> Mailing Address PO BOX 2239 <br /> LODI, CA 95241 <br /> Care of EHLERS, STEVEN K <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0017131 10185943 <br /> Facility Name EHLERS FAMILY FARMS <br /> Location 15248 HWY 12 <br /> ISLETON, CA 95541 <br /> Phone 209-334-5911 <br /> Mailing Address PO BOX 2239 <br /> LODI, CA 95241 <br /> Care of EHLERS, STEVEN K <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 06903035 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 AR0030013 New Account ID: <br /> Mail Invoices to Owner r/� Mail Invoices to: Owner I Facility 1 Account <br /> Account Name EHLE YFARMS C f (Circle Ore) <br /> Account Balance as of 2/17/201 $292.00 i��1— <br /> f (Circle One) <br /> ,�'` Transfer to Actiwellnai <br /> ProgramFEtement and Description Record ID bloyee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525316 Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PR0530584 EE0001422-ARIS VELOSO Active Y N A D <br /> 2830-AST FAC -SPCC EXEMPT PR0530583 EE0001422-ARIS VELOSO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533691 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENTI,the undersigned owner,operator or agent of same,acknowledge that all site,ancilor project specific,PHSIEHD 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 andlor Standards and State ancilor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! / <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date / 1 <br /> Water System to be TRANSFERED: Amount Paid Date / I <br /> Payment e Check Number Received by Lb <br /> REHS: a �� "L' Date 1�_! Account out: Lb Date :)--1 1 f <br /> �01'j /-.-) C, 45 T fs <br />