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Dale run 2/2013 4:11:15PR SAN J. UIN COUNTY ENVIRONMENTAL HOW DEPARTMENT Report#5021 <br /> Run hY / Paget <br /> Facility Information as of 2/20/2013 <br /> Record Selection Criteria: Facility ID FA0016996 <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 OW0013837 New Owner ID <br /> Owner Name ARLIND FONTES FARMS <br /> Owner DBA ARLIND FONTES FARMS <br /> Owner Address 27500 BLOSSOM RD <br /> THORNTON, CA 95686 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 53 <br /> THORNTON, CA 95686 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility l0 FA0016996 /VCL <br /> Facility Name ARLIND FONTES FARMS <br /> Location 27500 BLOSSOM RD <br /> THORNTON, CA 95686 <br /> Phone 209-794-2677 x0 <br /> Mailing Address PO BOX 53 <br /> THORNTON, CA 95686 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOIS District 004 -VOGEL, KEN Fax <br /> APN 00113032 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 AR0029878 New Account ID: <br /> Maillnvoicesto Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name ARLINDFARMS (clrcleone) <br /> Account Balance as of 2/20/2013: 53.0 <br /> (chole one) <br /> Tran nerr to Acdvelete e <br /> ProgreMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525181 Active Y N A 0 D <br /> 2830-AST FAC -SPCC EXEMPT PRO529098 EE0001422-ARIS CACAPIT Active,Exempt Y N A0 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH.PRO533572 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project specirw. <br /> P argeeeeaociated with this facility <br /> or activity will be billed to Me party Identified as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes an )dsndndor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / I <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 Receive <br /> REHS: /r1 lzlt41L Date_�!�_/ _ Acoount out: Date�_/_ <br /> COMMENTS: n r <br /> r U It cLLf i✓ cod e���u.e /n U o C� �3 <br /> qI (,l r? ��ca "i�°L 12erRe� . <br />