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Date run 3/26/2015 11:11:23AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by t r. . Pagel <br /> Facility Information as of 3/26/2015 <br /> Record Selection Criteria: Facility ID FA0021048 <br /> a Make chanN <br /> FORMATION CHANGE(date) <br /> F1 copy OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax to <br /> Owner ID OW0017326 New Owner ID <br /> Owner Name SILVA, ANN TRUST q'146F O'k, <br /> Owner DBA <br /> Owner Address 18700 S BACCHETTI RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-9063 <br /> Mailing Address 18700 S BACCHETTI RD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0021048 10187753 <br /> Facility Name BACCHETTI &SILVA FARM Qc I+1 •cI� na ri <br /> Location 18700 S BACCHETTI RD ` <br /> TRACY, CA 95304 <br /> Phone 209-835-9063 <br /> Mailing Address 18700 S BACCHETTI RD <br /> TRACY, CA 95304 <br /> Care of SILVA,ANN TRUST TNS 1 <br /> Location Code Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 21212005 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION n I— <br /> Contact Name Jqr[ A <br /> Title <br /> Day Phone `5vy—tea <br /> Night Phone 3 9 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0037878 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name BACCHETTI &SILVA FARM (Circle One) <br /> Account Balance as of 3/26/2015: 4521 <br /> (Circle One) <br /> Transfer to Activelinactve <br /> PrograMElemenl and Description Record ID Employee ID and Name Status New Omer' Delete <br /> 1958-HM-Farm Operations PR0525837 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 222#-SM HW GEN<5 TONS/YR PRO529336 J EE0002646-THUY TRAN Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO629304 EE0002646-THUY TRAN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532740 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and'or project specific,PHSfEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form l also certify that all operations will be performed in accordance with all applicable Ordinance Codes andror Standards and State andfor <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> REHS: '4n Na��l� Date�_/ �l 7/1� Account out: Date 1 /�' <br /> COMMENTS: <br /> Or'l� <br />