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Dat, un ,6,2009 123:1OPM SANJf- ZUIN COUNTY ENVIRONMENTAL HEA"H DE PARTM ENT Report <br /> Run by <br /> +.r Facility Information as of 2/6/200 Pagel <br /> Record Selection Cmeda. F.1dy ID FA0017279 <br /> Make changea/eofrections in RED ink or pencil. <br /> Q INFORMATION CHANGE(date) <br /> p(\ OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner 10 OW0014120 New Owner to <br /> Owner Name S-K RANCH (SHATTO) 7y�—� � 7�T� <br /> Owner DBA S-K RANCH (SHATTO) <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 15 <br /> FARMINGTON, CA 95230 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017279 <br /> Facility Name S-K RANCH (SHATTO) <br /> I <br /> LINDEN, CA 95236 <br /> Phone 209-886-5493 x0 <br /> Mailing Address PO BOX 15 <br /> FARMINGTON, CA 95230 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EM", <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name 7-11L7 ,S CvA/�U,2y <br /> Title <br /> Day Phone c, <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030161 New Account to <br /> Mail Invoices to Owner Mail Invoices to. Owner I Facility / Account <br /> Account Name S-K RANCH (SHATTO) O"JeOOe) <br /> Account Balance as of 2/6/2009: $42.00 <br /> ICrde OMI <br /> Tranale,to ACtrve/mwIye <br /> propryNElem irl and Desorption Riad 10 Employee ID and Name Status New owner' Delete <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525464 Active y N A I D <br /> BILLING and COWtL1NCE ACKNOVJLEDGEMENP. I.the uMxslgrod vwsler,operala a agent of same,acknmAedge that all alts,ands pgod e0atldc.PHStEHD hmrlY manges assn-Md vAh M <br /> fadey a aC&"oma bobead to the pony oentd m lne O W1JER on Ns form t also taffy mal as operalbns wi be pMwrred in arcade deal gS appacede Orarace Codes aroma Standeb aid <br /> Stale alWa Fedwal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Reeei <br /> RENS: Date 2/ /_�/ Account out <br /> COMIENTB: % <br /> C, SEs . <br /> \\eh-env\envision\reports\5021.rpt <br />