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Date run 2/27/2015 1 38:55AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Fief _a <br /> Facility Information as of 2/27/2015 <br /> Record Selection Criteria: Facility ID FA0021048 <br /> Make changes/corrections 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 OW0017326 New Owner ID <br /> Owner Name SILVA, ANN TRUST <br /> Owner DBA <br /> OwnerAddress 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 ID/CERS ID FA0021048 10187753 <br /> Facility Name RA!`Q IF=T-n a c_II vn FARM <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 <br /> Location Code Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 21212005 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 AR0037878 NewAccount 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 2/27/2015: $292.00 <br /> (Circle One) <br /> �'� Transfer to ActIveAOacive <br /> Program/Element and Description Record ID Employee ID and Nem Status New Omer? Delete <br /> 1958-HM-Farm Operations, PR0525837 EE0002474 MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0529336 EE0002646- Active Y N A I D <br /> 28 -AST FAC -SPCC EXEMPT PR0529304 EE0002646-THUY TRAN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532740 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator Or agent of same,acknowledge that all site,ander project specific,P7S/EHO hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form I also cently that all operations will be performed in accordance with all applicable Ordinance Codes anclor Standards and State andror <br /> Federal Laws. A\\ <br /> APPLICANTS SIGNATURE: �1 L I`�1 " 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: Date /_/_ Account out: Date <br /> COMMENTS: <br /> �sL��ss sz'Lb. P L.-e4sAPkib vl s C77, {}c���-- �S 7� L. L <br /> �� I <br />