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Date run 9/22/2004 2:33:07PN SAN Jl UIN COUNTY ENVIRONMENTAL HE, H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/22/2004 <br /> Record Selection Criteria: Facility ID FA0003382 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002508 Case Number: 002452 New Owner ID <br /> Owner Name CORREIA, JOSE &ALEXANDRINA <br /> Owner DBA CORREIA TRUST, JOSE &ALEXAN <br /> Owner Address 24544 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-838-2344 <br /> Mailing Address 24544 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Care of CORREIA, JOSE &ALEXANDRINA <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003382 <br /> Facility Name CORREIA TRUST, JOSE &ALEXAN 39-339 <br /> Location 24712 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Phone 209-838-2344 <br /> Mailing Address 24544 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Care of <br /> Location Code 99 - UNINCORPORATED AREA APN: <br /> BOS District 004 - SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002959 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CORREIA TRUST, JOSE &ALEXAN 39-339 (Circle One) <br /> Account Balance as of 9/22/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2011 -GRADE A DAIRY PR0200073 EE0009374-LARRY GODINHO Active Y N A I D <br /> 2785-EMPLY HOUSING/EXEMPT DAIRY PR0515604 EE0009374-LARRY GODINHO Active Y N A I 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 <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />