Laserfiche WebLink
Date run 1/23/2012 10:15:02AI SANK JUIN COUNTY ENVIRONMENTAL HES FI DEPARTMENT Report#5021 <br />Run by 5290 Pagel <br />Facility Information as of 1/23/20— <br />Record Selection Criteria: Facility ID FA0017497 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0014338 <br />Owner Name <br />FLYING M DAIRY <br />Owner DBA <br />FLYING M DAIRY <br />Owner Address <br />26230 S UNION RD <br />Phone <br />MANTECA, CA 95337 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />26230 S UNION RD <br />MANTECA, CA 95337 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0017497 <br />Facility Name <br />FLYING M DAIRY <br />Location <br />6524 PERRIN RD <br />MANTECA, CA 95337 <br />Phone <br />209-239-4164 <br />Mailing Address <br />26230 S UNION RD <br />MANTECA, CA 95337 <br />Care of <br />Location Code <br />BOS District <br />APN 25712001 <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 />Mail Invoices to Owner <br />Account Name <br />Account Balance as of 1/23/2012: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />NewOwnerlD <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 />Program/Element and Description Record ID Employee ID and Name 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 Active Y N A I D <br />Active,Exempt Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHPRO534734 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 be performed in accordance with all applicable Ordinace Codes and/or Standards and <br />State and/or Federal Laws. <br />APPLICANTS SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS <br />\\eh-env\envision\reports\5021. rpt <br />* $25.00 = <br />Date <br />Date ! /, <br />Amount Paid Date <br />_ Amount Paid Date <br />Received by <br />Account out: A— Date <br />