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Date run 12/16/2014 4:24:25P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 05021 <br /> Run by 1273 <br /> Facility Information as of 12/16/2014 Pagel <br /> Record Selection Cmens: Facility ID FA0003365 <br /> Make changesicorrections 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 /> Owner Address 23335 E DODDS RD L S <br /> ESCALON, CA 95320 Uri. 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 lD/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-VOGEL, KEN Fax <br /> APN 20716004 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title p <br /> Day Phone 209-838-7737 <br /> Night Phone <br /> DEC 16 2014 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002942 ENVIRONMENT MEALiH New Account ID: <br /> Mail Invoices to Facility PERMIT/SERVICES Mail Invoices to: Owner / Facility / Account <br /> Account Name C M L BORBA RANCH INC 39-347 (circle One) <br /> Account Balance as of 12/16/2014: $0.00 <br /> (Circle One) <br /> Tmnsferto Active/InacWe <br /> Pmglam/Element and DescriptionRecord ID Employee ID antl Name Status New Owne0 Delete <br /> 1958-HM-Farm Operations PRO525785 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2011 -GRADE A DAIRY PR0200060 EE0004589-KADEANNE LINHARES Inactiv[ Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0530160 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2765-EMPLOYEE HOUSING-PERMANENT>180 DAYS PR0515642 EE0002089-OMRAN SOOD Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO530159 EE0001 421 -STACY RIVERA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533190 Inactivt 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: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHS/EHD hourlycharges associatedwith thisfacility <br /> or activity will be billed to the party identifietl as the OWNER on this forth. I also certify that all operations will be perrormed in accordance with all applicable Ordinance Codas andor Standards and State anchor <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 Rem a by <br /> RENS: Date_/_/ Account out: Date 2/ 1 S /157 <br /> COMMENTS: <br />