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Date run 7/26/2004 9:57:46AN SAN JCJ#UIN COUNTY ENVIRONMENTAL HE Report#5021 <br /> Run by <br /> Facility Information as of 7/26/2 U4' DEPARTMENT Pagel <br /> Record Selection Criteria: Facility ID FA0009495 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0007495 Case Number: H04577 New Owner ID <br /> Owner Name RIPPEY, DENNIS <br /> Owner DBA LODI VINTNERS INC <br /> Owner Address 1580 HENRY RD <br /> NAPA, CA 94558 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-368-5338 <br /> Mailing Address PO BOX 549 <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009495 <br /> Facility Name LODI VINTNERS INC <br /> Location 3750 E WOODBRIDGE RD <br /> ACAMPO, CA 95220 <br /> Phone 209-368-5338 <br /> Mailing Address PO BOX 549 <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:01320007 <br /> BOS District 004 -SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016495 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name RIPPEY, DENNIS (Circle One) <br /> Account Balance as of 7/26/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> New Owner? Delete <br /> 2214-CaIARP FAC STATE SURCHARGE FEE PRO518974 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511783 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2226-CaIARP PROGRAM PRO514600 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520121 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509495 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4430-SOLID WASTE CIA SITE PR0519129 EE0003973-ROBERT MCCLELLON Inactive 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-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />