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Date run 5/12/2014 10:21:09AI SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 5112/2014 <br /> Record Selection Criteria: Facility ID FA0019099 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID <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 209-824-3651 <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/CERS ID FA0019099 <br /> Facility Name DELICATO FAMILY VINEYARDS <br /> Location 12001 S HIGHWAY 99 <br /> MANTECA, CA 95336 <br /> Phone <br /> Mailing Address 12001 S HIGHWAY 99 <br /> MANTECA, CA 95336 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 003- BESTOLARI DES Fax <br /> APN 20405014,23,24 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 AR0034011 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name KLEINFELDER (Circle One) <br /> Account Balance as of 5/12/2014: $0.00 <br /> (Circle One) <br /> Transfer to ActiveMactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2965-WATER QUALITY SITE PROJECT PRO528241 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,anNor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party ident?ed as the OWNER on this farm I also candy that all operations will be Performed in accordance with all applicable Ordinance Codes anclor Standards and State ardor <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date / I <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 <br /> COMMENTS: <br />