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Date run 3/14/2014 8:33:33AR SAN JO�UIN COUNTY ENVIRONMENTAL HEAI%%N�DEPARTMENT Report#5021 <br /> Run by <br /> ' <br /> Facility Information as of 3/14/2014 Pagel <br /> Record Selection Criteria: Facility ID FA0016798 <br /> Make changestcorrections 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 Specified <br /> Mailing Address 2445-8EBA-&T-tAN-BR.- C-6L- s fnt+L, ''0Cm5-RA • <br /> �t1I2tOE1� Ef�95382 Sock-akari CA. 9S21S— 11iZ2 <br /> Care of .._. <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016798 10185423 <br /> Facility Name JOHN TONJUM <br /> Location 20479 CALIFORNIA FARMS RD <br /> STOCKTON, CA 95215 <br /> Phone 209-465-2108 x0 <br /> Mailing Address -244,5-SEZM-,S-T}AN-8F;�., 2.014"19 Cp.��t tD�Y110. �0.YYYl5 ��• <br /> -TURL-OCK;eA-95382 <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 / Account <br /> Account Name JOHN TONJUM (Circle One) <br /> Account Balance as of 3/14/2014: $53.00 <br /> (Circle One) <br /> Transferto Activetinactve <br /> Program/Element 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 PRO531374 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andrDr project specific,PHS/I=-HL)hourly charges associated with this facility <br /> or activEty 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 /> APPLICANTS SIGNATURE: Date 1 I <br /> Program Records to be TRANSFERED; *$25.00= Amount Paid Date / 1 <br /> Water System to be TRANSFERED: Amount Paid Date I 1 <br /> Payment Type Check Number Recei y } <br /> REHS: Date I I Account out: Date 3 J 1 f <br /> COMMENTS: <br />