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Date run 1/21/2011 12:06:24PI SAN JO." —UIN COUNTY ENVIRONMENTAL HEAT `J ^EPARTMENT Report#5021 <br />Run by 5290 Pagel <br />Facility Information as of 1/21/20 <br />Record Selection Criteria: Facility ID FA0016999 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0013840 <br />Owner Name <br />J&D VINEYARDS <br />Owner DBA <br />J&D VINEYARDS <br />Owner Address <br />LODI, CA 95241 p <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />LODI, CA 9&242 - <br />Care of <br />FACILITY FILE INFORMATION <br />FacilityID <br />FA0016999 <br />Facility Name <br />J&D VINEYARDS <br />Location <br />23201 N RAY RD <br />LODI, CA 95242 <br />Phone <br />209-334-6072 x0 <br />Mailing Address <br />LODI, CA 95242 <br />Care of <br />Location Code <br />BOS District <br />APN 01119008 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0029881 <br />Mail Invoices to Owner <br />Account Name J&D VINEYARDS <br />Account Balance as of 1/21/2011: $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 />lS4 alp L� � ►� {ZD <br />S <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 />2223 - AGRICULTURAL HAZ MAT STORAGE FACILPRO525184 Active Y N A I D <br />11,2830 - AST FAC - SPCC EXEMPT PRO530408 EE0001422 - ARIS CACAPIT Active,Exempt Y N A I D <br />ERSC - ELECTRONIC REPORTING SURCHARGE PRO533170 Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENTI, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly 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 />State and/or Federal Laws, <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: ' $25.00 = <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: Date <br />COMMENTS: <br />\\eh-env\envision\reports\5021. rpt <br />Date <br />Amount Paid Date <br />_ Amount Paid Date <br />Received by <br />Account out: t,J Date <br />