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Date mn 7/26/2004 10:47:21AI SAN JUIN COUNTY ENVIRONMENTAL HE H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/26/2 � <br /> Record Selection Criteria: Facility ID FA0003867 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002861 New Owner ID <br /> Owner Name DELICATO VINEYARDS <br /> Owner DBA DELICATO VINEYARDS <br /> Owner Address 12001 S HWY 99 <br /> MANTECA, CA 95336 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-824-3600 <br /> Mailing Address 12001 S HWY 99 <br /> MANTECA, CA 95336 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003867 <br /> Facility Name DELICATO VINEYARDS <br /> Location 12001 S HWY 99 <br /> MANTECA, CA 95336 <br /> Phone 209-824-3600 <br /> Mailing Address 12001 S HWY 99 <br /> MANTECA, CA 95336 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:20405008 <br /> BOS District 003- MOW, VICTOR SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003455 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name DELICATO VINEYARDS (Circle One) <br /> Account Balance as of 7/26/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inachm <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner' Delete <br /> 1615-RETAIL MKT<2000 SO FT (PREPKGD/LT PR0505063 EE0006213-VIDAL PEDRAZA Active Y N A I D <br /> 2214-CaIARP FAC STATE SURCHARGE FEE PR0518951 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513762 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511591 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2226-CaIARP PROGRAM PRO514556 EEc000000-HAZ MAT SJC DES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0519530 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2299-WASTE GENERATING RECYCLER PR0517456 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84) PR0231599 EE0007289-ALISON YOUNGBLOODInactive Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PRO517441 EE0007289-ALISON YOUNGBLOODActive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509303 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 4443-SW COMPOST SITE PR0507825 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0460815 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,andlor project speck,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 Ordinate 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\epps\Envisions\Reports\5021.rpt <br />