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I z ,l9,& Run by : CARL San Joaquin County PHS/EHD Report 5021 FACILITY INFORMATION as of 01/29/98 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Make changes/corrections in RED p n or.pencil: OWNER FILE INFORMATION INFORMATION CHANGE (date): ! 2� OWNERSHIP CHANGE (date): OWNER ID: 000024 New Owner ID: OO Owner Name: BOGGIANO, J & M Owner DBA: LINDEN ORCHARDS LC#54 owner Address: 22261 E STOLTE RD LINDEN, CA 95236 Home Phone - NQ Soc Sec# / Tax ID#: Ownership Type: 01 CORPORATION Mailing Address: 22261 E STOLTE RD Care of: BOGGIANO, J & M LINDEN, CA 95236 FACILITY FILE INFORMATION FACILITY ID: 000031 A Facility Name: LINDEN ORCHARDS 39-54 Location: 21100 E FRAZIER RD LINDEN 95236 Phone: � Mailing Address: 1540 NEWPORT AVE 22-26/ ,C— Care of: JOSE GARCIA STOCKTON, CA 95205 Location Code: 9 9 APN: BOS District: 004 SIC Code: ACCOUNTS RECEIVABLE FILE INFORMATION ACCOUNT ID: 0000031 New Account ID: 000 Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account Account Name: LINDEN ORCHARDS 39-54 (Circle one) Account Balance as of 01/29/98 : $0 . 00 (Circle one) Record UST(s) Transfer to Activate / Inactivate P/E Description ID Employee Status Linked new owner? Delete - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2755 EMPLOYEE HOUSING PR270054 0843 COLLINS ACTIVE Y N A I D 4633 TNC WS WA504886 0644 ACTIVE Y N A I D - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PR Records to be TRANSFERED: x $20.00 = Amount Paid Date—/—/ Water System to be TRANSFERED: x $150.00 = Amount Paid Date—/—/ Payment Type Check # Recvd by ------------------------------------------- REHS or COUNTER SUPV: JC. Date ACCT out: AZ,_ Date/�/C?ZS UNIT/File:—/—/ i