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Date run 1/31/2013 2:21:14PR SAN X*UIN COUNTY ENVIRONMENTAL HE* DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/31/2013 <br /> Record Selection Criteria: Facility ID FA0017108 <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 OW0013949 New Owner ID <br /> Owner Name RENWICK FARM <br /> Owner DBA RENWICK FARM <br /> Owner Address 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 f <br /> Home Phone Not Specified [, <br /> Work/Business Phone Not Specified VU Mailing Address 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017108 <br /> Facility Name RENWICK FARM <br /> Location 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Phone 209_484-6678 x0 <br /> Mailing Address 9011 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 06311020 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029990 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name RENWICK FARM (Circle One) <br /> Account Balance as of 113112013: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> HM-Farm Operations PR0525293 Active Y N A I D <br /> - <br /> 2220 SM HW GEN<5 TONS/YR PR05303911 EE0001422-ARIS CACAPIT Active Y N A D <br /> AST EXEMPT FAC < 1,320 GAL PR0530390 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHoPR0533583 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENTI,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD 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 andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Recoived b <br /> REHS: {{0 Date '9-1 Account out: Date -2-1-1 1 <br /> COMMENTS: <br />