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01 <br /> Date run 3/2:~/2014 2:57:53K SAN JOi JIN COUNTY ENVIRONMENTAL HEAT —WDEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 3/25/2014 Pagel <br /> Record Selection Criteria: Facility ID FA0016798 <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 SSKI 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 /> WorklBusiness Phone Not Specified <br /> Mailing Address-204:7 -F--ORN1A-FARMSZM— 14q - 5V-. <br /> sT-eeKTON-CA 952`-5-942-2-- — `l-i�r ock CA. <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERSID FA0016798 10,185,423 <br /> Facility Name JOHN TONJUM <br /> Location 20479 CALIFORNIA FARMS RD <br /> STOCKTON, CA 95215 <br /> Phone 209465-2108 <br /> Mailing Address 2-o4-79-CA-ElFORNIA F KR-M RD X445 Sega- - o vl 1) C. <br /> STOCKTON-CX-9521"5=942-2-- -TLA-r- lock._ CA CtS3'32_-7oo3 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 20517001 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 AR0029680 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility / Account <br /> Account Name JOHN TONJUM (Circle One) <br /> Account Balance as of 3/25/2014: $53.00 <br /> (Circle One) <br /> Transferto Activellnactve <br /> ProgramfElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-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 PR0531374 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSlEHD 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 V operations will be performed in accordance with all applicable Ordinance Codes andror Standards and State andror <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date 1 ! <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I 1 <br /> Water System to be TRANSFERED: Amount Paid Date ! 1 <br /> Payment Type Check Number Received / <br /> RENS: Date I I Account out: Civ - Date �3 1Q-6-_1 I7` <br /> COMMENTS: <br />