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Date run 2/16/2010 10:22:24AI SAN JC tUIN COUNTY ENVIRONMENTAL HEA- 'H DEPARTMENT Report#5021 <br /> Runk ''� Pagel <br /> Facility Information as of 2/16/2 <br /> Record Selection Criteria: Facility ID FA0018151 <br /> !�- Make changes/corrections in RED ink. <br /> E INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014894 New Owner ID <br /> Owner Name BIGLIERI FARMS <br /> Owner DBA BIGLIERI FARMS <br /> Owner Address 20360 E COLLIER RD <br /> CLEMENTS, CA 95327 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 604 <br /> CLEMENTS, CA 95227 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018151 ��Ac--r(✓I> a a L� <br /> Facility Name BIGLIERI FARMS <br /> Location 20360 E COLLIER RD <br /> CLEMENTS, CA 95327 <br />/ <br /> Phone 209-759-3201 xO <br /> Mailing Address PO BOX 604 <br /> CLEMENTS, CA 95227 <br /> Care of <br /> Location Code Aft Phone <br /> BOS District Fax <br /> APN 02118016 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031921 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name BIGLIERI FARMS (CircteOne) <br /> Account Balance as of 2/16/2010: $280.00 <br /> (Circle One) <br /> Transfer to Acttvellnactve <br /> Progranweement and Description Retard ID Employee ID and Name Status New Owner' Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO530517 EE0001422-ARIS CACAPIT — Y N A V D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO526794 Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO530516 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533744 Active Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned ovmer,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity mi be filled to Me parry identiriM as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State aM/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date I / <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type �,y5'—Check Number Receive by <br /> REHS: I"fy k Date /t If 0 Account out: Date .-.2- <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />