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Date run 1/31/2013 2:22:22PN SAN J( UIN COUNTY ENVIRONMENTAL HEA -IDEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 1/31/2013 <br />Record Selection Criteria: Facility ID FA0016693 <br />OWNER FILE INFORMATION <br />Owner ID <br />OVV0013534 <br />Owner Name <br />THOMPSON RANCH <br />Owner DBA <br />THOMPSON RANCH <br />Owner Address <br />7603 S JACK TONE RD <br />STOCKTON, CA 95215 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />7603 S JACK TONE RD <br />STOCKTON, CA 95215 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID FA0016693 <br />Facility Name THOMPSON RANCH <br />Location 7603 S JACK TONE RD <br />STOCKTON, CA 95215 <br />Phone 209-943-0260 x0 <br />Mailing Address 7603 S JACK TONE RD <br />STOCKTON, CA 95215 <br />Care of <br />Location Code 99 - UNINCORPORATED P <br />Bos District 002 - RUHSTALLER, LARRY <br />APN 18117002 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0029575 <br />Mail Invoices to Owner <br />Account Name THOMPSON RANCH <br />Account Balance as of 1/31/2013: $0.00 <br />Program/Element and Description <br />Record ID <br />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 Ownerin <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/lnactve <br />Status New Owner? Delete <br />M -Farm Operations PR0524878 Active Y N A I U <br />SM HW GEN <5 TONS/YR PR0530308 EE0002670 - MUNIAPPA NAIDU Active Y N A I D <br />0 -AST FAC SPCC EXEMPT PR0530306 EE0002670 -MUNIAPPA NAIDU Active,Exempt Y N A I D <br />ERSC ELECTRONIC REPORTING STATE SURCH4PR0532146 Inactive Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andror project specific, PHSlEHD 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 andlor <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS: <br />Date <br />$25.00 = Amount Paid Date <br />Amount Paid Date <br />Date / / <br />QUf- <br />Recei e 11 <br />Account out: Date <br />21�3I�3 <br />51 <br />