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Date run 2/15/2017 11:49:36AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Rspol#5021 <br /> Run by <br /> Facility Information as of 2/15/2017 Pagel <br /> Record Selection Criteria: Facility ID FA0016887 <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 10 <br /> Owner ID OW0013728 New Owner ID <br /> Owner Name ABA FARMS <br /> Owner DBA ABA FARMS <br /> Owner Address 16505 S TRACY BLVD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-0406 <br /> Mailing Address 16505 S TRACY BLVD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016887 10185571 <br /> Facility Name ABA FARMS <br /> Location 9447 HOWARD RD <br /> STOCKTON, CA 95206 <br /> Phone 209-835-0406 x0 <br /> Mailing Address 16505 S TRACY BLVD /„ ) <br /> TRACY, CA 95304 <br /> Care of Steve Arnaudo ` <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 18915006 EMsil: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name A �` t <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029769 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ABA FARMS (Circle One) <br /> Account Balance as of 2/15/2017: $306.00 <br /> (Circle One) <br /> Transfer to ActivennacNe <br /> Progmm/Elemern and Description Transfer ID Employee ID and Name Status Nev,Owner? Delete <br /> 1958-HM-Farm Operations PRO525072 EE0002670-MUNIAPPA NAIDU Active Y N D <br /> 2220-SM HW GEN<5 TONS/YR PRO539996 EE0000026-CESAR RUVALCABA Active Y N A <br /> 2830-AST FAC -SPCC EXEMPT PRO530352 EE0001459-VICKI MCCARTNEY Inactive Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531856 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,arknowledga that all site,andcr protect spectre,PHSVEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also cartify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <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 b <br /> EHD Staff: Z � • /v�iNyL. Date��/ ?�,/,� Account out: Date �-'/Zg / 7 <br /> COMMENTS'. <br /> D Invoice#: <br /> 1 I{ A6 CJ t/ 1 <br /> l�e� <br />