Laserfiche WebLink
Date run 2/11/2015 3:11:07PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ReportON21 <br /> Run by Pagel <br /> Facility Information as of 2/11/2015 <br /> Record Selection Criteria: Facility to FA0009440 <br /> Make changes/corrections in RED ink. '' <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0007440 Case Number: H04013 New Owner ID <br /> Owner Name GEORGE, DOUG <br /> Owner DBA DOUG GEORGE/GEORGE FARMS <br /> Owner Address 18743 BRENNAN RD <br /> ESCALON, CA 953209705 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 18743 S BRENNAN RD <br /> ESCALON, CA 953209705 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009440 10182673 <br /> Facility Name DOUG GEORGE/GEORGE FARMS <br /> Location 18719 S BRENNAN RD <br /> ESCALON, CA 95320 <br /> Phone 209-838-1067 x0 <br /> Mailing Address 18743 S BRENNAN RD <br /> ESCALON, CA 953209705 <br /> Care of <br /> Location Code 99- UNINCORPORATED.4 Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 24702023 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 AR0016440 1 r vNew Account ID: <br /> Mail Invoices to Owner Jfi 1' r 'I�•, Mail Invoices to: Owner / Facility / Account <br /> Account Name GEORG , G � t�GV arY' (Circle One) <br /> Account Balance as of 2/11/2015: $79.00 �5�1 <br /> CUP (Circle One) <br /> Transfer to Aclive4nactve <br /> Prograrn/Element and Descrlplion Record to Employee to and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525912 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511728 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PRO514589 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509440 EE0000000-HAZ MAT SJC OES Inactive Y N AD <br /> 2 3 AST FAC -SPCC EXEMPT PR0529187 EE0009001 -ELENA MANZO Active Y N A I D <br /> SC-ELECTRONIC REPORTING STATE SURCHARG PR0533819 Inactive Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project specific,PHSIEHD 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 andror Standards and Stale andror <br /> Federal Law. r ^ Au�' SK/A_ P <br /> APPLICANT'S SIGNATURE: 7Q J Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date ! / <br /> Paymentz <br /> Check Number Received by <br /> REHS: � k t&l �R_ Date -2-111 Account out: Date oZ/ 7 / 75 <br /> COMMENTS: <br />