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Date run 3/6/2014 8:42:34AM SAN J' UIN COUNTY ENVIRONMENTAL HE/ DEPARTMENT Report#5021 <br />Rt n by - Pagel <br />Facility Information as of 3/6/20-l4 <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 />MACHADOWACHADO DAIRY <br />Owner Address <br />26230 S UNION RD <br />A D <br />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 />State and/or <br />MANTECA, CA 95337 <br />Care of <br />APPLICANT'S SIGNATURE: Date <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 />Account ID AR0030379 <br />Mail Invoices to Owner <br />Account Name MACHADO/MACHADO DAIRY <br />Account Balance as of 3/6/2014: $266.00 <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 />Mail Invoices to: <br />New Acco u nt I D: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transferto <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 D <br />2220 - SM HW GEN <5 TONS/YR PR0531028 EE0009001 -ELENA MANZO Active Y N <br />A D <br />d <br />2830 - AST FAC - SPCC EXEMPT PR0531027 EE0009001 - ELENA MANZO Active,I Y N <br />A D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0534734 Inactive Y N <br />A 1 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 <br />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 andtor Standards and <br />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 Type rnCl'�t.t Check Number Rece'v d by <br />F-777 <br />REHS: P. Q � � Io Date n l Q! / 1(4 Account out: I� Date 3 l)q <br />COMMENTS: _ r. o ,� <br />I ✓ e- }l�W"'P_ W (I V-YiT l� f) �Ll W l `I � ` � nojp -r Y —/� ocvv3 ._1 <br />(1 �f <br />p <br />Q� `U� r i'l'lOC.G�ca d C) o k <br />