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E <br /> un 2/9/2015;Facility <br /> 54:40AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 05021 <br /> Pagel <br /> Facility Information as of 2/9/2015 by; <br /> Criteria: ID FA0005283 <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: 1 SSN/Fed Tax ID <br /> Owner ID OW0004139 New Owner ID <br /> Owner Name Julia Heckenlaible <br /> Owner DBA HECKENLAIBLE FARMS INC <br /> Owner Address 14117 N LOCUST TREE RD <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-993-0820 <br /> Mailing Address 14117 North Locust Tree Road <br /> Lodi, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility IDICERSID FA0005283 10181787 <br /> Facility Name ERNESTHEFEENLAFBtE— ec -P–Y1 I a-tlnLI1 <br /> Location 14117 N LOCUST TREE RD <br /> LODI, CA 95240 <br /> Phone 209-993-0819 x <br /> Mailing Address 14117 North Locust Tree Road <br /> Lodi, CA 95240 <br /> Care of Dwayne Heckenlaible <br /> Location Code 99- UNINCORPORATED,6 Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN El <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005744 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name Julia Heckenlaible Circle One) <br /> Account Balance as of 2/9/2015: $292.00 <br /> (Circle One) <br /> Transfer to AciWe?InacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525804 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0529482 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2333-FARM UST#1 FACILITY-obsolete PR0501961 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO529481 EE0001 422-ARIS VELOSO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531745 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor protect specific PHSiEHD hourly charges associated with this facility <br /> or activity will be billed to the party idea ified 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 Stale 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,l77�yvp1e Check Number Receive y <br /> RENS: �C�BI RB EP,� Date_ Account out: Date <br /> COMMENTS: Nam, I t� <br />