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Date run 7/17/2013 9:56:56Ah SAN JOWIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report 115021 <br /> Run by Pagel <br /> Facility Information as of 7/17/2013 <br /> Recortl Selection Criteria: Facility ID FA0021823 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0017968 New Owner ID <br /> Owner Name JOHNSON, ANDREW <br /> Owner DBA AJ RANCH INC <br /> Owner Address 3060 CALLE BONITA <br /> SANTA YNEZ, CA 93460 <br /> Home Phone 714-334-9414 <br /> Work/Business Phone Not Specified <br /> Mailing Address 3060 CALLE BONITA <br /> SANTA YNEZ, CA 93460 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0021823 <br /> Facility Name JOHNSON, ANDREW <br /> Location 26250 N MIDSECTION ST <br /> THORNTON, CA 95686 <br /> Phone <br /> Mailing Address 3060 CALLE BONITA <br /> SANTA YNEZ, CA 93460 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039731 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ODIC ENVIRONMENTAL (Circle One) <br /> Account Balance as of 7/17/2013: $-875.00 <br /> (Circle One) <br /> Transferto ActiveAnactve <br /> PrograWElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0537841 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this torn l also certify that all operations will be performed in accordance with all applicable Ordinance Codes ander Standards and State andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date I / <br /> COMMENTS: <br />