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Date run 4/24/2013 3:14:43PR SAN JC 7IN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/24/2013 <br /> Record Selection Criteria: Facility ID FA0017029 <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 OW0013870 New Owner ID <br /> Owner Name POMBO 7P CATTLE COMP <br /> Owner DBA POMBO 7P CATTLE COMP <br /> Owner Address 1755 W 11TH ST <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address i <br /> TRACY, CA-9'S,77— <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017029 10,185,781 <br /> Facility Name POMBO 7P CATTLE COMP <br /> Location 24100 LAMMERS RD <br /> TRACY, CA 95377 <br /> Phone 209-835-4949 x0 <br /> Mailing Address 1755 W 11TH ST <br /> TRACY, CA 95376 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 24002007 Entail: �(_ j pry �!f jn: t,&-I, <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029911 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name POMBO 7P CATTLE COMP (Circle One) <br /> Account Balance as of 4/24/2013: $266.00 <br /> (Circle One) <br /> Transfer to Aclive/Inaclve <br /> Program/Element and Description . Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525214 Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0530967 EE0002646-THUY TRAN Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0530966 EE0002646-THUY TRAN Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHiPR0531706 Inactive 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 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 and/or Standards and 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 Check Number Received by <br /> REHS: � X04 Date 041" / 115 Account out: Date / <br /> COMMENTS: t• <br /> 20 �� L,Iz61, 1 -? <br />