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Date run 1131/2013 2 21:14Ph SAN JUIN COUNTY ENVIRONMENTAL HE* DEPARTMENT Report#5o2t <br /> Run by Pagel <br /> Facility Information as of 1f31/2013 <br /> Record Selection Criteria' Facility ID FA001 7148 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner ID OW0013949 New Owner ID <br /> Owner Name RENWICK FARM <br /> Owner DBA RENWICK FARM <br /> Owner Address 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017108 <br /> Facility Name RENWICK FARM <br /> Location 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Phone 209-484-6678 x0 <br /> Mailing Address 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 06311020 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 AR0029990 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name RENWICK FARM (Circle One) <br /> Account Balance as of 113112013: $0.00 <br /> (Circle One) <br /> Transfer to Activerinaetve <br /> PrograrrVElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> SHM-Farm Operations PR0525293 Active Y N A I D <br /> 2220-SM HW GEN t5 TONSIYR PR0530391 EE0001422-ARIS CACAPIT Active Y N A D <br /> AST EXEMPT FAC < 1,320 GAL PR0530390 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH�PR0533583 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENTS I,the undersigned owner,operator or agent of same,acknowledge that all site,andfer 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 and/or Standards and State anrYor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! I <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date I 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> REHS: t 0 Date 2:1:1 _1 Account out: Date i 1 1 t <br /> COMMENTS: <br />