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Report#5029 <br /> Date run 211312!}14 91;42:41AI SAN JUIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Pagel <br /> Run by f- � r <br /> Facility Information as of 2/1312014 <br /> Record Selection Criteria: Facility ID FA0016798 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID : <br /> Owner ID OW0013639 New Owner ID <br /> Owner Name JOHN TONJUM <br /> Owner DBA JOHN TONJUM <br /> Owner Address 20479 CALIFORNIA FARMS RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specifier <br /> Mailing Address 2 aqqs- Se"VLO-.t a Y <br /> Tv'r,ack , C.d, 95382 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0016798 10,185,423 <br /> Facility Name JOHN TONJUM <br /> Location 20479 CALIFORNIA FARMS RD <br /> STOCKTON, CA 95215 <br /> Phone 209-465-2108 x0 <br /> Mailing Address p `t'-1 S A"-&.i 7(1>f- <br /> eeifi 5 'T'.,r 1dCIL . CA. 4S'5%-A__ - <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 20517001 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 AR0029680 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name JOHN TONJUM (Circle One) <br /> Account Balance as of 2/13/2014: $53.00 <br /> (Circle One) <br /> Transfer to Aclivellnactve <br /> ProgramlElemeni and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1956-HM-Farm Operations PRO524983 Active Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO530726 EE0001421 -STACY RIVERA Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531374 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that ali site,andlor 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 andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 I <br /> Program Records to be TRANSFERED: $25.00 4 Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date 1 I <br /> Payment Type Check Number Receiv d <br /> RE'Hs: Date I 1 Account out: Date _! 1 <br /> COMMENTS: <br />