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rob vn ^6/10/2015 3:40.28PN SAN JO UIN COL"YTY ENVIRONMENTAL HEA :I DEPARTMENT Report*5021 <br /> Run by �/ V Pagel <br /> Facility Information as of 6/10/2015 <br /> Record Selection Criteria: Facility 1D FA0016887 <br /> Make changeslcorrections 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 OW0013728 New Owner ID <br /> Owner Name ABA FARMS <br /> Owner DBA ABA FARMS <br /> Owner Address 16505 S TRACY BLVD I, <br /> TRACY, CA 9533 i <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 /> BOIS District 003- BESTOLARIDES, STEVE Fax <br /> APN 18915006 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 AR0029769 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ABA FARMS (ChcleOne) <br /> Account Balance as of 6/10/2015: $213.00 <br /> (Circle One) <br /> Transfer to Activallnactue <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525072 EE0009817-ROBERT LOPEZ Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO539996 EEOOG5642-MICHELLE HENRY Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO530352 EE0002646-THUY TRAN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531856 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent a same,acknowledge that all site,al project specific.PHSEHO 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 anNor Standards end Stet.enbbr <br /> Fedi lLaws. <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 / / Account out: Date / 2-1 <br /> COMMENTS: <br /> Invoice#: <br />