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Date ran 12120/2016 3:39:19P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Run by <br /> Report#5421 <br /> Facility Information as of 12120/2016 Pagel <br /> Record Selection Crrterra: Facility ID FA0009941 <br /> Make changesicorrections in RED ink.. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION Number Of facilities for this owner OWNERSHIP CHANGE(date). 1 <br /> SSN/Fed Tax ID <br /> Owner ID <br /> OW0007941 Case Number: H05938 New Owner ID <br /> Owner Name RON & DEANNA GOEHRING <br /> Owner DBA GOEHRING PUMP & IRRIGATION <br /> Owner Address 17754 N HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Home Phone Not Specified <br /> Work/Business Phone 209_727-5548 <br /> Mailing Address PO BOX 113 <br /> LOCKEFORD, CA 95237 <br /> Care cf <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009941 10183047 <br /> Facility Name GOEHRING PUMP & IRRIGATION <br /> Location 17754 N HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Phone 209-727-5548 x <br /> Mailing Address PO BOX 113 <br /> LOCKEFORD, CA 95237 <br /> Care of Ron Goehring <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> SOS District 004 -WINN, CHARLES Fax <br /> APN 05125010 EMaii <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016941 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility 1 Account <br /> Account Name GOEHRING PUMP & IRRIGATION (Circle One) <br /> Account Balance as of 12120/2016: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee If]and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0519976 EE0008709-JAMIE LIMA Active Y N AI D <br /> 2220-SM HW GEN<5 TONSIYR PRO514103 EE0001422-ARIS VELOSO Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512229 EE0000000-HAZ MAT SJC OES Inactivf Y N A D <br /> 2333-EXCLUDED FARM TANK PR0501799 EE0000005-FATIN'AH ZAREEF Inactiv€ Y N A I D <br /> 2399-UNIFIED PROGRAM FAG STATE SURCHARGE Fl PRO509941 EE=0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0535643 EE0001422-ARIS VELOSO Inactivf Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PRO531999 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 specs ic,PHS/EHD hourly charges associated with this facilely <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 andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE Date ! f <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date ! ! <br /> Water System to be TRANSFERED. Amount Paid Date / ! <br /> Payment Ty e Check Number _ Received <br /> EHD Staff: Date 11 Account out: Date�11 /4 <br /> COMMENTS: <br />&AS') n no Ion yr 1'nones+jun . ve6 .� fi� Invoice <br /> �Y) -h L <br />