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Date run 7/26/2005 4:41:10PK SAN JO )IN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report 95021 <br /> Run by 4006 Pagel <br /> Facility Information as of 7/26/20 <br /> Record Selection Criteria: Facility ID FA0016043 <br /> Make chaINFORMATI N C in RED inkorpencil. <br /> ® INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0003358 New Owner ID <br /> Owner Name Q Ail. E . Zo[ ' <br /> Owner DBA l.�ooD Ba.Lnc-F (�1.7 L `f <br /> Owner Address PO BOX 1260 <br /> WOODBRIDGE, CA 95258 <br /> Home Phone Not Specified Zfl 3 69 <br /> Work/Business Phone 7-Q7-226-j3-C6— <br /> Mailing Address PO BOX 1260 <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016043 <br /> Facility Name WOODBRIDGE WINERY/ROBERT MONDA\ <br /> Location 5950 E WOODBRIDGE RD <br /> ACAMPO, CA 95258 <br /> Phone 209-369-5861 <br /> Mailing Address PO BOX 1260 <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN 01709058 <br /> BOS District 004 -SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027975 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name KENNEDY/JENKSCONSULTANTS (Circle One) <br /> Account Balance as of 7/26/2005: $0.00 <br /> (Circle One) <br /> Transfer to Activivinatva <br /> New Omer? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2965-WATER QUALITY SITE PROJECT PRO523822 EE0000997-HARLIN KNOLL 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 spec,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 anctor Federal Laws. <br /> APPLICANTS 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 "1((� <br /> REHS: Date / / Account out: Date-7/ ;-7 /0L <br /> COMMENTS: <br /> \Dhs-ehsal-nt\apps\envisions\reports\5021.rpt • • <br />