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Date run 1/24/2012 11:19:17A S..IJ JC UIN COUNTY ENVIRONMENTAL HEA" t DEPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 1/24/21, <br /> Record Selection Criteria: Facility ID FA0017212 <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 OW0014053 New Owner ID <br /> Owner Name A&R OWNING FARMS I-I_C17986 <br /> Owner DBA A&R OWNING FARMS LLC17986 <br /> Owner Address 17590 E COPPEROPOLIS RD <br /> STOCKTON, CA 95215 <br /> Home Phone 209-481-6583 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1548 BENNINGTON CT D pi e-.W I',i'YLAC4-t, � <br /> STOCKTON, CA 95209 6} q6;2- — 1?&/ 3 <br /> Care of OWNING, ALLEN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017212 <br /> Facility Name A&R OWNING FARMS LLC17986 <br /> Location 17986 E COPPEROPOLIS RD <br /> STOCKTON, CA 95215 <br /> Phone 209-465-4696 x0 <br /> Mailing Address 1548 BENNINGTON CT /q�,a-0 E <br /> STOCKTON, CA 95209 k-b At, 611- qp- � <br /> Care of OWNING, ALLEN <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 18320010 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 AR0030094 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name A&R OWNING FARMS LLC17986 (Circle One) <br /> Account Balance as of 1/24/2012: $0.00 <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 PR0529711 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525397 Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO529710 EE0009488-JEFFREY WONG Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0531632 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 /> Slate 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 / 1 <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: L�6 _ Date� <br /> COMMENTS: <br /> DE S <br /> \\eh-env\envision\reports\5021.rpt <br />