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Datemn 1/28/2011 12:31:23PI SAN UIN COUNTY ENVIRONMENTAL HE DEPARTMENT ' Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 1!28/2011 <br /> Record Selection Criteria: Facility ID FA0017006 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013847 New Owner ID <br /> Owner Name CORTOPASSI PARTNERS INC <br /> Owner DBA CANAL RANCH FARMS <br /> Owner Address 11292 N ALPINE RD <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 11292 N ALPINE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017006 <br /> Facility Name CANAL RANCH <br /> Location 23187 N BLOSSOM RD a3D1 r✓- A) aC D/fI <br /> THORNTON, CA 95686 <br /> Phone 209-948-0792 XO <br /> Mailing Address 11292 N ALPINE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 01103002 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOE HERNANDEZ <br /> Title RANCH MANAGER <br /> Day Phone 209-948-0792 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029888 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name CORTOPASSI PARTNERS INC (Circle One) <br /> Account Balance as of 1/28/2011: $0.00 <br /> (Circle One) <br /> Program/Element and Description Record ID Employee ID and NameSalus Transfer to Activellnactve <br /> New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO529105 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525191 Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO529101 EE0001 422-ARI S CACAPIT Active,Exempt Y N A 1 D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO532479 Active 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,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this farm. I also certify that all operations will be performed in accordance with all applicable Ordinaee Codas and/or Standards and <br /> State andfor 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 /> RENS: D,attee L/ / / Account out: Date /,7— <br /> COMMENTS' ,7—COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />