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Date run} 12/18/2017 3:50:04P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 12/18/2017 <br /> Record Selection Criteria: Facility ID FA0003366 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0002489 Case Number: 002448 New Owner ID <br /> Owner Name C M L BORBA RANCH INC <br /> Owner DBA <br /> OwnerAddress 23285 E DODDS RD <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-838-1648 <br /> Mailing Address 23335 E DODDS RD <br /> ESCALON, CA 95320 <br /> Care of BORBA, LAWRENCE; BORBA, MIKE <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0003365 10181115 <br /> Facility Name C M L BORBA RANCH INC 39-347 <br /> Location 23335 E DODDS RD <br /> ESCALON, CA 95320 <br /> Phone 209-838-7737 <br /> Mailing Address 23335 E DODDS RD <br /> ESCALON, CA 95320 <br /> Care of <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 20716004 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 209-838-7737 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002942 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name C M L kORBARANCH INC 39-347 (CirUeOne) <br /> Account Balance as of 12/18/2017: 154 00 elg �S <br /> (Cimle One) <br /> Transfer to Active/Il <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525786✓ EE0002670-MUNIAPPA NAIDU Active Y N A® D <br /> 2011 -GRADEA DAIRY PR0200060 EED005362-NICHOLAS WIESEMAN Inactive Y N A_ D <br /> 2220-SM HW GEN<5 TONS/YR PR0530160 EE0000032-JOHN ALANIZ Active Y IN A-- , D <br /> 2765-EMPLOYEE HOUSING-PERMANENT>180 DAYS PRO515642 EE0006987-SCOTT SANGALANG Inactive Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO630169 EE0000032-JOHN ALANIZ Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO533190 Inactive Y N A I D <br /> 4617-EMPLOYEE HOUSING-WATER SUPPLY WA0515736 EE0004589-KADEANNE LINHARES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific,PHSFEHD 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 sector Standards and State and'or <br /> Federal Laws. <br /> APPLICANTS 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 /> EHD Staff: Date 1/0 Account out: � Date <br /> COMMENTS: 41�r <br /> T� <br /> Invoice#: <br />