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Date run 3/2/2015 3:31:33PM SAN JO 'JIN COUNTY ENVIRONMENTAL HEA' ` DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 3/2/2015 <br />Record Selection Criteria: Facility ID FA0019445 <br />OWNER FILE INFORMATION Number of facilities for this owner <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 />209-794-2515 <br />Mailing Address <br />7581 W KILE RD <br />Location Code <br />LODI, CA 95242 <br />Care of <br />004 - WINN, CHARLES <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0019445 10187237 <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 />7581 W KILE RD <br />LODI, CA 95242 <br />Care of <br />STOKES, THOMAS J <br />Location Code <br />99 - UNINCORPORATED P <br />BOS District <br />004 - WINN, CHARLES <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 3/2/2015: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />2 SSN/Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />2830 - AST FAC - SPCC EXEMPT PRO529141 EE0001422 - ARIS VELOSO Active,l Y N A0 D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andror 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: Co✓I✓� Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type Check Number Received Q�by, <br />REHS: K -1A <br />• YV2l�yr Date �_/�/ _ Account out: �J Date <br />COMMENTS: <br />dA p.". 4-41 klv lc. <br />4 cj4r.'� V,4— A'V <br />