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Date run 1/23/2002 1:28:32PM SAN JOAQUIN COUNTY Report u: 5023 <br /> Run by Facility Information as of 1/23/2002 - Page # 1 <br /> Record Selection Criteria: Facility ID FA0003408 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0003057 Case Number: 002448 New Owner ID <br /> Owner Name: TOLEDO, TONY <br /> Owner DBA: TOLEDO DAIRY#1 <br /> Owner Address: 26222 N ELLIOTT RD <br /> GALT, CA 95632 <br /> Home Phone: Not Specified <br /> Work/Business Phone: 209-369-9226 <br /> Mailing Address: 26222 N ELLIOTT RD <br /> GALT, CA 95632 <br /> Care of: TOLEDO, TONY <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0003408 <br /> Facility Name: TOLEDO DAIRY#1 <br /> Location: 26222 N ELLIOTT RD <br /> GALT, CA 95632 <br /> Phone: 209-368-7311 <br /> Mailing Address: 26222 N ELLIOTT RD <br /> GALT, CA 95632 <br /> Care of: TOLEDO, TONY <br /> Location Code: 99 - UNINCORPORATED AREA APN: <br /> BOS District: 004 -SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0003824 New Account ID: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: TOLEDO DAIRY#1 (Circle One) <br /> Account Balance as of 1/23/2002: $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 /> 2011 -GRADE A DAIRY PR0200134 EE0000018-ROBIN TRINDADE Active Y N A I D <br /> Pi3'EMPLY HOUSING/DAIRY PENDING EXEMPT PRO515618 EE0000018-ROBIN TRINDADE Active Y N A� D <br /> a1$9 :27.s S <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 <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: "$150.00= Amount Paid Date <br /> Payment Type Check Number Rec _ <br /> REHS: Date / / — Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />