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F <br /> 2/218/2044 3:25:44PA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Facility Information as of 2/2812014 Pagel <br /> ion Criteria: Facility ID FA0017074 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> SSN I Fed Tax ID <br /> Owner ID OW0013915 New Owner ID <br /> Owner Name CHEROKEE RANCH -SCHENONE <br /> Owner DBA CHEROKEE RANCH - SCHENONE <br /> Owner Address 14400 E HWY 26 <br /> LINDEN, CA 95236 <br /> Home Phone Not Specified <br /> WorklBusiness Phone Not Specified <br /> Mailing Address 14400 E HWY 26 <br /> LINDEN, CA 95236 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0017074 10,185,853 <br /> Facility Name CHEROKEE RANCH -SCHENONE <br /> Location 8953 E CHEROKEE <br /> STOCKTON, CA 95215 <br /> Phone 209-481-8931 x0 <br /> Mailing Address 14400 E HWY 26 <br /> LINDEN, CA 95236 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 08718216 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 AR0029956 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name CHEROKEE RANCH -SCHENONE (Circle One) <br /> Account Balance as of 2128/2014: $53.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525259 Active Y N A D <br /> 2840-AST EXEMPT FAC c 1,320 GAL PRO530579 EE0000753-WILLY NG Active,l Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533471 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all 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_ t also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State and'or <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date 1 <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 <br /> Water System to be TRANSFERED: Amount Paid Date I I <br /> Payment p Check Number Rec Iv y <br /> RENS: Date 7`I I Account out: Date I I <br /> ow 11 <br /> (ErNt Schcmv-.., thiS <br /> C N W�Jm_� trw cm l� <br /> r )/d1%f <br />