Laserfiche WebLink
Date run 1/14/2011 11:14:11AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEA7 TH DEPARTMENT Report #5021 <br />Run by 1278 Pagel <br />Facility Information as of 4/14/2, , I <br />Record Selection Criteria: Facility ID FA0017497 <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 Rece've <br />REHS: Date / / Account out: Date ! l z <br />COMMENTS: /A A-11 <br />\\eh-env\envision\reports\5021.rpt <br />Make changes/corrections in RED ink. <br />1 <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />SSN / Fed Tax ID <br />Owner ID OW0014338 <br />New Owner ID <br />Owner Name MACHADO/MACHADO DAIRY <br />Owner DBA HADOf —E3A+RY <br />Owner Address 26230 S UNION RD <br />MANTECA, CA 95337 <br />Home Phone Not Specified <br />Work/Business Phone Not Specified <br />Mailing Address 26230 S UNION RD <br />MANTECA, CA 95337 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID FA0017497 <br />Fiv P6 1 41 R=V <br />Facility Name MACHADO/MACHADO DAIRY <br />Location 6524 PERRIN RD <br />MANTECA, CA 95337 <br />Phone 209-239-4164 x0 <br />Mailing Address 26230 S UNION RD <br />MANTECA, CA 95337 <br />Care of <br />Location Code <br />Alt Phone <br />BOS District <br />Fax <br />APN 25712001 <br />EMail: <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0030379 <br />New Account ID: <br />Mail Invoices to Owner <br />Mail Invoices to: Owner / Facility / Account <br />Account Name MACHADO/MACHADO DAIRY <br />(Circle One) <br />Account Balance as of 4/14/2011: $0.00 <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name <br />Status New Owner? Delete <br />2220 - SM HW GEN <5 TONS/YR PR0531028 EE0002670 - MUNIAPPA NAIDU Active Y N A I D <br />2223 - AGRICULTURAL HAZ MAT STORAGE FACILPRO525682 <br />Active Y N A I D <br />2830 - AST FAC - SPCC EXEMPT PR0531027 EE0002670 - MUNIAPPA NAIDU Active,Exempt Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHPR0534734 <br />Active 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 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 <br />be performed in accordance with all applicable Ordinace Codes and/or Standards and <br />State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 Rece've <br />REHS: Date / / Account out: Date ! l z <br />COMMENTS: /A A-11 <br />\\eh-env\envision\reports\5021.rpt <br />