Laserfiche WebLink
Date run 11/7/2018 9:03:01AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by DONNA Pagel <br />Facility Information as of 11/7/2018 <br />Record Selection Criteria: Facility ID FA0017184 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0014025 <br />Owner Name <br />SCATENA FAMILY TRUST <br />Owner DBA <br />SCATENA FAMILY TRUST <br />OwnerAddress <br />3724 W KINGDON RD <br />2840 -AST EXEMPT FAC < 1,320 GAL PR0531073 EE0000753 - WILLY NG <br />LODI, CA 95242 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />3724 W KINGDON RD <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT. I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated with this facility <br />LODI, CA 95242 <br />Care of <br />Federal Laws. <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0017184 10186035 <br />Facility Name SCATENA FAMILY TRUST <br />Location 3724 W KINGDON RD <br />LODI, CA 95242 <br />Phone 209-369-3867 x0 <br />Mailing Address 3724 W KINGDON RD <br />LODI. CA 95242 <br />Care of <br />Location Code <br />BOS District <br />APN 05525019 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0030066 <br />Mail Invoices to Owner <br />Account Name SCATENA FAMILY TRUST <br />Account Balance as of 11/7/2018: $101.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID <br />Alt Phone <br />Fax <br />EMail : <br />New Account ID: <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inaclve <br />ProgramLElemerttan Record ID Employee ID and Name <br />Status <br />New Owner? <br />to <br />-1358 - HM -Farm Opera' PR0525369 EE0002670 - MUNIAPPA NAIDU <br />Active <br />Y N <br />A D <br />2840 -AST EXEMPT FAC < 1,320 GAL PR0531073 EE0000753 - WILLY NG <br />Inactive <br />Y N <br />A D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0534430 <br />Inactive <br />Y N <br />A D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT. I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or 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 <br />andlor Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: ` $25.00 = Amount Paid Date J / <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type C eck/�Number Received by <br />EHD Staff: ��� �� .�LtiT Date ��/ / Account out: Date <br />COMMENTS: / I 1 If1V01 #k: <br />Mrs • C p. �" e rte. 0.SSe r S ��np.+ � o r� CA v�fn Gtv� v� O lS ore e n <br />0.-�rcx_C)r sC, w�,� c��e we-- btlIli. �neIr <br />