Laserfiche WebLink
Date run 2/17/2015 10:20:55AI SAN J( UIN COUNTY ENVIRONMENTAL HEA .'DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 2/17/2015 <br />Record Selection Criteria: Facility ID FA0016760 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0013601 <br />Owner Name <br />Donald Gallagher <br />Owner DBA <br />GALLAGHER VINEYARDS <br />OwnerAddress <br />5714 PEACH AVE <br />Location 5714 PEACH AVE <br />MANTECA, CA 95337 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-823-6416 <br />Mailing Address <br />5714 PEACH AVE <br />Manteca, CA 95337 <br />MANTECA, CA 95337 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) 2 �% <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID/CERS ID FA0016760 10185363 <br />Facility Name GALLAGHER VINEYARDS <br />Location 5714 PEACH AVE <br />MANTECA, CA 95337 <br />Phone 209-823-6416 x <br />Mailing Address 5714 Peach Ave <br />Manteca, CA 95337 <br />Care of Donald Gallagher <br />Location Code Alt Phone <br />BOS District Fax <br />APN 22603003 Entail: <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0029642 New Account ID: <br />Mail Invoices to Accountail Invoices to: <br />Owner / Facility / Account <br />Account Name GALLA NEYARDS A �u! � a49 <br />(Circle One) <br />Account Balance as of 2/17/2015 $292.00 r (��`�/y�� fz' <br />APf� SV I.6V•/ <br />(Circle One) <br />1 / <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name <br />Status New Owner? Delete <br />1958 - HM -Farm Operations PR0524945 EE0002474 - MICHAEL PARISSI <br />Active Y N A I D <br />2220 - SM HW GEN <5 TONS/YR PR0530687 EE0009001 - ELENA MANZO <br />Active Y N A I D <br />2830 AST FAC - SPCC EXEMPT PR0530686 EE0009001 - ELENA MANZO <br />Active Y N AD <br />0 <br />ELECTRONIC REPORTING STATE SURCHARGI PR0533249 <br />Inactive Y N A 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 <br />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: Date <br />Program Records to be TRANSFERED: * $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment T pe ✓,/ Check Number Received by <br />REHS: 1 fib.. 1 F� �c�to. Date !2 Account out: _ Date <br />� / 1 / I`J - <br />COMMENTS: <br />P( Qc, n <br />