Laserfiche WebLink
Daterun L9/2011 11:50:17AM SAN JO*'1UIN COUNTY ENVIRONMENTAL HEA' 7-1 DEPARTMENT Report#5021 <br /> Run ti.0 5290 Pagel <br /> Facility Information as of 2/9/20 , <br /> Record Selection Criteria: Facility ID FA0016680 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013521 New Owner ID <br /> Owner Name DELTA TREE FARMS INC <br /> Owner DBA DELTA TREE FARMS INC <br /> Owner Address 11251 N HAM LN <br /> LODI, CA 95242 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 11251 N HAM LN <br /> LODI, CA 95242 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016680 <br /> Facility Name DELTA TREE FARMS INC <br /> Location 11251 N HAM LN <br /> LODI, CA 95242 <br /> Phone 209-334-4545 x0 HAI 6t�l <br /> Mailing Address 11251 N HAM LN <br /> LODI, CA 95242 7uiz ' <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 05907012 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 AR0029562 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name DELTA TREE FARMS INC (Circle One) <br /> Account Balance as of 2/9/2011: $67.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1-11 <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO524865 Active Y N A D <br /> 2830-AST FAC -SPCC EXEMPT PR0530497 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533081 Active 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 hourly charges asso 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 /> 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 Check Number Receiye4 by <br /> RENS: Date / / Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />