Laserfiche WebLink
Date run 8/9/2013 3:22:56PM SAN JO;' 1IN COUNTY ENVIRONMENTAL HEAL" ' DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/9/201,) <br /> Record Selection Criteria: Facility ID FA0003360 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002487 Case Number: 002452 New Owner ID <br /> Owner Name ROCHA, FRANK N AND KATHY <br /> Owner DBA FRANK N ROCHA DAIRY#1 <br /> Owner Address 23125 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-838-1297 <br /> Mailing Address 23125 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Care of FRANK N ROCHA <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0003360 <br /> Facility Name ROCHA, FRANK N DAIRY#1 39-345 <br /> Location 23243 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Phone 209-838-1297 <br /> Mailing Address 23125 E LONE TREE RD <br /> ESCALON, CA 95320 <br /> Care of ROCHA, FRANK N <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 20736008 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ROCHA, FRANK N <br /> Title <br /> Day Phone 209-838-1297 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002937 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ROCHA, FRANK N DAIRY#1 39-345 (Circle One) <br /> Account Balance as of 8/9/2013: $0.00g� /2 C� �/ (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description / Record ID Employee ID and Name Status New Owner? Delete <br /> 2011 - DE A DAIRY �S PR0200119 EE0005362-NICHOLAS WIESEMAN Active Y N A I D <br /> 2 EXE' <br /> XE PT TANK FACILITY PR0502826 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 5- PT <br /> HOUSING-PERMANE T>180 DAYS PR0515635 EE0002089-OMRAN SOOD Active Y N A I D <br /> AIRY- WATER SUPPLY WA0515607 EE0004589-KADEANNE LINHARES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ancl/or project specific,PHS/EHD hourly charges associated with this facility <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 and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <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 />