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Dale :n 6P46/2013 11:02:41AI SAN JC�JIN COUNTY ENVIRONMENTAL HEA 1 DEPARTMENT Rewrlas021 <br /> Hun by �/ Pagel <br /> Facility Information as of 3/26/2013 <br /> Record Selection Criteda: Facility IO FA0016858 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013699 New Owner lD <br /> Owner Name NOMA VINEYARDS <br /> Owner DBA NOMA VINEYARDS <br /> Owner Address 13600 N CURRY AVE <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 13600 N CURRY AVE <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0016858 10,185,521 ���✓�'t� <br /> Facility Name NOMA VINEYARDS <br /> Location 13600 N CURRY AVE <br /> LODI, CA 95240 <br /> Phone 209-334-9420 x0 <br /> Mailing Address 13600 N CURRY AVE <br /> LODI, CA 95240 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 06113258 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 AR0029740 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name NOMAVINEYARDS (Circle One) <br /> Account Balance as of 3/26/2013: $53.00 <br /> (Circle One) <br /> Transfer to ActivenacNe <br /> PrograMElement and Description Record ID Employee ID antl Name Status New Omer? Delete <br /> 1958-HM-Farm Operations PRO525043 Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529276 EE0000753-WILLY NG Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHfPR0532124 Inactive Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,endor project speufc,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identdied as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anni Standards and State andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERE ^$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / I <br /> Payment Type Check Number Received b 0 <br /> REHS: Date / C*/ f3 Account out Date / <br /> COMMENTS C <br /> MAR 2 g 2013 <br /> ")ik Ti ilk-7� ENT NEPLIN <br /> ENPE ftM1M�SER�ICES <br />