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Date run 9/14/2004 1:02:54PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/14/20. <br /> Record Selection Criteria: Facility ID FA0003438 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002561 Case Number: 002451 New Owner ID <br /> Owner Name MACHADO, ALICE F TRUST <br /> Owner DBA CIRCLE J M DAIRY, LP <br /> Owner Address 8723 E MELTON RD <br /> MANTECA, CA 95337 <br /> Home Phone 209-599-2640 <br /> Work/Business Phone Not Specified <br /> Mailing Address 8723 E MELTON RD <br /> MANTECA, CA 95337 <br /> Care of ALICE MACHADO TRUST <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003438 <br /> Facility Name CIRCLE J M DAIRY LP 39-419 <br /> Location 8940 E MELTON RD <br /> MANTECA, CA 95337 <br /> Phone 209-599-2640 <br /> Mailing Address 8723 E MELTON RD <br /> MANTECA, CA 95337 <br /> Care of MACHADO, ALICE F TRUST <br /> Location Code 99- UNINCORPORATED AREA APN:25722016 <br /> BOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003015 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CIRCLE J M DAIRY LP 39-419 (Circle One) <br /> Account Balance as of 9/14/2004: $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 PR0200021 EE0009374-LARRY GODINHO Active Y N A I D <br /> 2775-EMPLY HOUSING/DAIRY PENDING EXEMPIPRO522128 EE0004486-Angelica Sandoval 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 /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />