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Dale run 6/6/2014 8:27:56AM SAN JO JIN COUNTY ENVIRONMENTAL HEAI 'DEPARTMENT Report#5021 <br /> Run by "'Ilietv Pagel <br /> Facility Information as of 6/6/2014 <br /> Record Selection Criteria: Facility ID FA0012458 <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: 3 SSN/Fed Tax ID <br /> Owner ID OW0009663 New Owner ID <br /> Owner Name SUTTER HOME WINERY INC <br /> Owner DBA <br /> Owner Address PO BOX 248 <br /> ST HELENA, CA 945740248 <br /> Home Phone Not Specified <br /> Work/Business Phone 707-963-3104 <br /> Mailing Address PO BOX 248 <br /> ST HELENA, CA 94574 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0012458 10340008 <br /> Facility Name SUTTER HOME WINERY INC. <br /> Location 18667 Jacob Brack Rd <br /> Lodi, CA 95242 <br /> Phone 209-368-5971 x <br /> Mailing Address 18667 JACOB BRACK RD <br /> LODI, CA 95242 <br /> Care of SUTTER HOME WINERY <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 01109003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ERIC JENSSEN <br /> Title VP ENGINEERING <br /> Day Phone 209-368-5971 <br /> Night Phone 707-963-5928 x2717 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR002031 New Account to: <br /> Mail Invoices to F�e<1 Mail Invoices to: Owner / Facility / Account <br /> Account Name S/UTT'ER HOME WINERY INC. (Circle 0.) <br /> Account Balance as of 6/6/2014: $558.00 <br /> (Circle Once) <br /> Transfer to Active)Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520830 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 1958-HM-farm Operations PRO524831 Inactivc Y N A I D <br /> 1963-CalARP PROGRAM 3 FACILITY PRO530013 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 1995-CaIARP FAC STATE SURCHARGE FEE PR0519005 EEo000000-HAZ MAT SJC DES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO537947 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO516098 EE0000000-HAZ MAT SJC DES Inactivc Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO516099 EE0009999-SITE UNASSIGNED Inactivc Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533778 Inactivc Y N A I D <br /> 4650-NTNC WATER SYSTEM W/TX WA0515761 EE0005838-ADRIENNE ELLSAESSER Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ardor project specific,PHS/EHD 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 ander 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 kCj_Number Rece'v <br /> REHS: IM1'`� Date / / Account out: <br /> COMMENTS: t <br />