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Date'run 11%7/2018 3:57:19PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 11/7/2018 <br />Record Selection Criteria: Facility ID FA0014064 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0021568 <br />Owner Name <br />PROPRIETARY FRUIT VARIETIES LP <br />Owner DBA <br />OwnerAddress <br />8363 AMSELL CT <br />Transfer to <br />CITRUS HEIGHTS, CA 95610 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />• 1958 - HM -Farm Operations <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0014064 10184555 <br />Facility Name PROPRIETARY FRUIT VARIETIES <br />Location 9296 E KETTLEMAN LN <br />LODI, CA 95240 <br />Phone 209-481-8588 <br />Mailing Address PO BOX 350 <br />LODI, CA 95240 <br />Care of ISABEL <br />Location Code 99 - UNINCORPORATED A <br />Bos District 004 - WINN, CHARLES <br />APN 06315059 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0023792 <br />Mail Invoices to Facility <br />Account Name PROPRIETAR UI VARIETIES <br />Account Balance as of 11/7/2018: $1 .00 <br />Make changesicorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />EMail : 0 <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: ' $25.00 = <br />Water System to be TRANSFERED: <br />Payment Type ^CIh(eck Number <br />EHD Staff: C'i E a Cl�CIS0-yl� Date <br />COMMENTS: <br />Date / !. <br />Amount Paid Date <br />Amount Paid Date <br />Received by g <br />/ LCE Account out: Date <br />I voice #: <br />A <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Program/Element and Description <br />Record ID Employee ID and Name <br />Status <br />New Owner? <br />tete <br />• 1958 - HM -Farm Operations <br />PR0525951 EE0002670 - MUNIAPPA NAIDU <br />Active <br />Y N <br />A D <br />2795 - EMPLOYEE HOUSING -HISTORICAL CAMPS <br />PR0518684 EE0002646 - THUY TRAN <br />Inactive <br />Y N <br />A D <br />2840 -AST EXEMPT FAC < 1,320 GAL <br />PR0529492 EE0000753 - WILLY NG <br />Inactive <br />Y N <br />A D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI <br />PR0534241 <br />Inactive <br />Y N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT, I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated with this facility <br />or activity 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 and/or Standards and State and/or <br />Federal Laws, <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: ' $25.00 = <br />Water System to be TRANSFERED: <br />Payment Type ^CIh(eck Number <br />EHD Staff: C'i E a Cl�CIS0-yl� Date <br />COMMENTS: <br />Date / !. <br />Amount Paid Date <br />Amount Paid Date <br />Received by g <br />/ LCE Account out: Date <br />I voice #: <br />A <br />