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Date run 7/23/2009 12:28:50PI SAN JO' -UIN COUNTY ENVIRONMENTAL HEA' ADEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/23/20Uy <br /> Record Selection Criteria: Facility ID FA0003671 <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 OW0002741 Case Number: 002442 New Owner ID : <br /> Owner Name MACHADO,*Nttl&6 & FRANK F <br /> Owner DBA MACHADO BROS <br /> Owner Address 12700 E LOUISE AVE <br /> MANTECA, CA 95336 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-823-6785 <br /> Mailing Address 12700 E LOUISE AVE <br /> MANTECA, CA 95336 <br /> Care of ANTHONY G & FRANK F MACHADO <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003671 <br /> Facility Name MACHADO BROS DAIRY 39-338 <br /> Location 12700 E LOUISE AVE <br /> MANTECA, CA 95336 <br /> Phone 2094i25--8-x% <br /> Mailing Address 12700 E LOUISE AVE <br /> MANTECA, CA 95336 <br /> Care of MACHADO BROS <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005- ORNELLAS, LEROY Fax <br /> APN 20817003 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MACHADO BROS <br /> Title 2 A <br /> Day Phone 209 <br /> Night Phone 209-815-5790 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003249 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MACHADO BROS DAIRY 39-338 (Circle One) <br /> Account Balance as of 7/23/2009: $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 /> 2011 -GRADE A DAIRY PR0200022 EE0005362-NICHOLAS WIESEMAN Inactive Y N A I D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525779 Active Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PR0508288 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2332-EXEMPT TANK FACILITY PR0234016 EE0007289-ALISON YOUNG BLOODActive,Exempt Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR1PR0507389 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2775-EMPLOYEE HOUSING-DAIRY EXEMPTION PR0515587 EE0005362-NICHOLAS WIESEMAN Active Y N A I D <br /> 4617-EMPLOYEE HOUSING-WATER SUPPLY WA0515740 EE0005362-NICHOLAS WIESEMAN 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 /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: e- ; Date_2 /_72-2,/&f-- Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />