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Date run 8/13/2013 10:03:09AI SAN JOB`, _N COUNTY ENVIRONMENTAL HEAL JEPARTMENT Report#5021 <br /> Run by I Pagel <br /> Facility Information as of 8/13/2013 <br /> Record Selection Criteria: Facility ID FA0003408 <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 OW0003057 Case Number: 002443 New Owner ID <br /> Owner Name TOLEDO, TONY (#1) <br /> Owner DBA TOLEDO DAIRY <br /> Owner Address 26222 N ELLIOTT RD <br /> GALT, CA 95632 <br /> Home Phone 209-368-7311 <br /> Work/Business Phone Not Specified <br /> Mailing Address 26280 N ELLIOTT RD <br /> GALT, CA 95632 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0003408 10,181,141 <br /> Facility Name TOLEDO DAIRY#1 39-334 <br /> Location 26222 N ELLIOTT RD <br /> GALT, CA 95632 <br /> Phone 209-368-7311 x0 <br /> Mailing Address 26280 N ELLIOTT RD <br /> GALT, CA 95632 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 00722005 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 209-368-7311 x0 <br /> Night Phone X0 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003824 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name TOLEDO, TONY(#1) (Circle One) <br /> Account Balance as of 8/13/2013: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525770 Active Y N A I D <br /> 2011 -GRADE A DAIRY PR0200134 EE0004589-KADEANNE LINHARES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0530410 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2775-EMPLOYEE HOUSING-DAIRY EXEMPTION PR0515618 EE0006219-LORI DUNCAN Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0530409 EE0001422-ARIS CACAPIT Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533529 Inactive Y N A I D <br /> 4620-DAIRY- WATER SUPPLY WA0515663 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,and/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 andror <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 />