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Data,ren '5/8/2012 2:47:04PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Ren by Pagel <br /> Facility Information as of 5/8/2012 <br /> Record Selection Criteria: Facility I FA0015392 <br /> Make changeslcorrectlons in RED ink. <br /> INFORMATION CHANGE(date) <br /> WNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION S /Fed Tax D :, <br /> Owner 1D OW0012358 Ne ner <br /> Owner Name WINDMILL SEPTIC SERVICE <br /> Owner DBA <br /> Owner Address P6-BAjE91Y <br /> RIPON, CA 95366 <br /> Home Phone 209-823-1315 <br /> Work/Business Phone Not Specified <br /> Mailing Address <br /> RIPON, CA 95366 <br /> Careof WINDMILL SEPTIC SERVICE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015392 <br /> Facility Name WINDMILL SEPTIC SERVICE <br /> Location 20504 S HWY 99 FRONTAGE RD <br /> RIPON, CA 95366 <br /> Phone 209-823-1315 <br /> Mailing Address 20504 S HWY 99 FRONTAGE RD <br /> RIPON, CA 95366 <br /> Care of <br /> Location Code 05 - RIPON Alt Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN 22806017 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RICK VAN LINEN <br /> Title <br /> Day Phone 209-823-1315 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026517 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name WINDMILL SEPTIC SERVICE (Circle One) <br /> Account Balance as of 5/8/2012: $0.00 <br /> (Circle One) <br /> Transfer to Activellnadve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PR0522594 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> 4244-PUMPER TRUCK PR0526150 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> 4244-PUMPER TRUCK PRO526151 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> 4244-PUMPER TRUCK PR0527381 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> 4246-PUMPER YARD PRO522595 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> 4255-CHEMICAL TOILETS PR0526152 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> X47400-WASTE TIRE SITE-EXEMPT PRO527075 EE0002620-ALFONSO ARAMBULA Active Y N I D <br /> B1iINGd COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned r,operator or agent of same,acknowledge that all site,andor project specific,PHS/EHD hourly charges assoaated�Nis facility <br /> or activity will be billed to the party identified as the OWNER on this=orrn so canih that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andfor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date _S_l r- <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Ty <br /> t Gc Number Received y <br /> REH Date / / Account out Date /2-- <br /> COMMENTS. n / <br />