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Date run 3/6/2014 8:42:34AM SAN JO AN COUNTY ENVIRONMENTAL HEAI DEPARTMENT Report#5021 <br />Rur,oy Pagel <br />Facility Information as of 3/6/2014 <br />Record Selection Criteria: Facility ID FA0017497 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0014338 <br />Owner Name <br />MACHADO/MACHADO DAIRY <br />Owner DBA <br />MACHADO/MACHADO DAIRY <br />Owner Address <br />26230 S UNION RD <br />A li. D <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 />Federal Laws. <br />MANTECA, CA 95337 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0017497 10,186,539 <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 />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 />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0030379 <br />Mail Invoices to Owner Mail Invoices to: <br />Account Name MACH E O/MA HADO DAIRY <br />Account Balance as of 3/6/2014.r2U 0C1J' <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />/ <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? <br />Delete <br />1958 - HM -Farm Operations PR0525682 Active Y N <br />A' 1 1 D <br />2220 - SM HW GEN <5 TONS/YR PR0531028 EE0009001 - ELENA MANZO Active Y N <br />A li. D <br />2830 - AST FAC - SPCC EXEMPT PRO531027 EE0009001 - ELENA MANZO Active,l Y N <br />A D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PRO534734 Inactive Y N <br />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 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 andlor Standards and <br />State andror <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 Tyle Check Number Rece v4Id/by <br />REHS: i'���1� CU t L7 Date ? /(1/_ Account out: �Y Date! / <br />COMMENTS: <br />-/L <br />1�C 1Vi Y C. Ali' 6)9V fQ1 S <br />