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Date run + 9/1/2021 12:09:OOPM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/1/2021 <br /> Record Selection Criteria: Facility ID FA0024683 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0023291 New Owner ID <br /> Owner Name AMB RANCH MANAGEMENT <br /> Owner DBA AMB AG ENTERPRISE <br /> OwnerAddress 28806 AVE 15 <br /> MADERA, CA 93638 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 559-674-5400 <br /> Mailing Address 28806 AVE 15 <br /> MADERA, CA 93638 <br /> Care of TRUJILLO, ELI <br /> FACILITY FILE INFORMATION APN <br /> Facility ID/CERS ID FA0024683 <br /> Facility Name AMB AG ENTERPRISE <br /> Location 28806 AVE 15 RD <br /> MADERA, CA 95638 <br /> Phone 559-674-5400 <br /> Mailing Address 28806 AVE 15 RD <br /> MADERA, CA 95638 <br /> Care of NAVARRO, MARIAH <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Hernandez,Abigail <br /> Title <br /> Day Phone 559-674-5400 <br /> Night Phone 559-363-9042 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0046188 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AMB AG ENTERPRISE (Circle One) <br /> Email invoice to(up to 2 emails) AMB.MNAVARRO@GMAIL.COM <br /> Email permit to(up to 2 emails) AMB.MNAVA RO@GMAIL.COM <br /> Account Balance as of 9/1/2021: $ 00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? /Delete <br /> 4244-PUMPER TRUCK PR0543484 EE0000039-AARON GOODERHAM -Ai5t4v Y ()N A U It <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 facilit <br /> 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 Ordinance Codes and/or Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / / �I H!V L� <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date / / C.� MAI-Qi� <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type I I4u er Receiv db 11 <br /> EHD Staff: Date/0 / / Account out: Date / / Z/ <br /> COMMENTS: <br /> Invoice#: <br />