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LZmaby <br /> 10/14/2009 3:57:02P SAN JOAnReport#5021 <br /> UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel <br /> 1273 �Il„r Facility Information as of 10/14/26.. <br /> Record Selection Criteria: Facility ID FA0019607 <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 OW0016073 New Owner ID <br /> Owner Name DEL RIO PARTNERS <br /> Owner DBA <br /> Owner Address 10749 W WOODBRIDGE RD <br /> LODI, CA 952429305 <br /> Home Phone 209-609-5452 <br /> Work/Business Phone Not Specified <br /> Mailing Address 10749 W WOODBRIDGE RD <br /> LODI, CA 952429305 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019607 <br /> Facility Name DEL RIO PARTNERS <br /> Location 10749 W WOODBRIDGE RD � <br /> LODI, CA 952429305 <br /> Phone 209-609-5452 <br /> Mailing Address 10749 W WOODBRIDGE RD <br /> LODI, CA 952429305 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 01103013 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account 1D AR0034904 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DEL RIO PARTNERS (Circle One) <br /> Account Balance as of 10/14/2009: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner'! Delete <br /> 2220-SM HW GEN<5 TONSNR PR0529646 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0529645 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: [,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party Identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Dale <br /> Payment Type Check Number Receive y <br /> REHS: fAIN Date ( 0 / I / Account out: Date <br /> COMMENTS: TT <br /> \\eh-env\envision\reports\5021.rpt <br />