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Date run 6/10/2009 10:16:58AI SAN JOA"'jIN COUNTY ENVIRONMENTAL HEAL"A DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 6/10/20u <br />Record Selection Criteria: Facility ID FA0019445 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0013851 <br />Owner Name <br />STOKES FARMS <br />Owner DBA <br />STOKES FARMS <br />Owner Address <br />7581 W KILE RD <br />Phone <br />LODI, CA 95242 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />7581 W KILE RD <br />Location Code <br />LODI, CA 95242 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0019445 <br />Facility Name <br />STOKES, THOMAS J <br />Location <br />12449 W WALNUT GROVE RD <br />THORNTON, CA 95686 <br />Phone <br />209-481-3165 <br />Mailing Address <br />T A 95686 <br />Care of <br />STOKES, THOMAS J <br />Location Code <br />BOS District <br />APN <br />00104023 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0034579 <br />Mail Invoices to Facility <br />Account Name STOKES, THOMAS J <br />Account Balance as of 6/10/2009: $0.00 <br />Program/Element and Description <br />Record ID Employee ID and Name <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID <br />l�•K-41 (CI <br />cd q:2jga <br />Alt Phone <br />Fax <br />EMail : <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />2830 - AST FAC - SPCC EXEMPT PR0529141 EE0001422 - ARIS CACAPIT Active,Exempt Y N 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 hourty charges associated with this <br />facility 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 Ordinace Codes and/or Standards and <br />Slate and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 Receiv <br />REHS: Date / / Account out: Date <br />COMMENTS: / <br />VLv <br />_ / S 1��� a �' i n su {h U�'1 t ad �� �Jaf <br />4,') K.,,,k- Ae;- t'�A <br />\\eh-env\envision\reports\5021. rpt <br />