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Date run 12!912003 .9:30:aAh SAN JOAQU N COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> 5 Facility Information as of 12/9/2003 <br /> Record selection Criteria: Facility ID FA0012689 <br /> Make changes/corrections In RED Ink or pencil. <br /> INFORMATION CHANGE(dale) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0009879 New Owner ID <br /> Owner Name PELLEGRI FARMS <br /> Owner DBA <br /> Owner Address 1 <br /> TRACY, CA 95376 <br /> Nome Phone 209_482-2520 <br /> Work/Business Phone Not Specified ¢� <br /> Mailing Address 1/ <br /> TRACY, CA 95376 <br /> Care of RICHARD PELLEGRI <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012689 <br /> Facility Name PELLEGRI FARMS <br /> Location 21606 EL RANCHO RD <br /> TRACY, CA 95376 a <br /> Phone 209-482-2520 ` <br /> Mailing Address 21606 EL RANCHO RD 4&dl <br /> TRACY, CA 95376 <br /> Care of RICHARD PELLEGRI <br /> Location Code 99 - UNINCORPORATED AREA APN: <br /> BOS District 005-ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021102 New Account ID: <br /> Mail Invoices to Account � !! f� _ Mail Invoices to: Owner / Facility I Account <br /> Account Name MONIER LIFETILE 311 !� " t vEkb ,be (cirdeone) <br /> Account Balance as of 121912003: $232.50 h"--p /4� Q a3 77 <br /> Transfer t6 (Circle One) <br /> Active/lnntve <br /> Program/Element and Description Record ID Employee tD and Name status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0516583 EE0000942-MARGARET LAGORIO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,ackr>4wledge that all site.and/or project specific.PHSlEHD hourty charges associated with this <br /> facility or activity will be billed to the party Identified as the OWNER on this form. I also certify that all operations MI be performed In accordance with all appiicatle Ordinate Codes andlor Standards and <br /> State and/or Federal Laws. q <br /> APPLI 3d Z (- L U�� Date I I <br /> Prog F MGItf— HfS <br /> Amount Paid Date 1 1 <br /> WaterI L , A 1 Amount Pald Date 1 ! <br /> Paym,' Cej"l�`I V r t Received by <br /> RENS ! Account out: D to ! ! � <br /> COMME <br /> p� ��l X22 y Y0 -4 <br /> 11Phs-ehsgl-ntlappslEnvisionslReports15021.tpt�-W <br /> a <br />