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Date run 81812014 9:24:44AM SAN JG IJIN COUNTY ENVIRONMENTAL HEA J DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 8/8/2014 Pagel <br /> Record Selection Criteria: Faciiity ID FAC017295 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN/Fed Tax ID <br /> Owner ID OVV0014136 New Owner ID <br /> Owner Name ALMEIDA ENTERPRISES <br /> Owner DBA ALMEIDA ENTERPRISES <br /> Owner Address 30092 E ORANGE AVE <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 30092 E ORANGE AVE <br /> ESCALON, CA 95320 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID J CERS ID FA0017295 10186231 <br /> Facility Name ALMEIDA ENTERPRISES <br /> Location 30092 E ORANGE AVE <br /> ESCALON, CA 95320 <br /> Phone 209838-8867 x0 <br /> Mailing Address 30092 E ORANGE AVE <br /> ESCALON, CA 95320 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 24915015 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 AR0030177 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name ALMEIDA ENTERPRISES (Circle One) <br /> Account Balance as of 81812014:-$479.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlUoment and Description Record T) Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525480 Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PR0529941 EE0009001 -ELENA MANZO Active Y N A D <br /> 2830-AST FAC -SPCC EXEMPT PRO529940 EE0009001 -ELENA MANZO Active,! Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532255 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENTS 1.the undersigned owner,operater or agent of same,acknowledge that all site,and/or project specific,PHSIEHU 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 wi l be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I ! <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid_ Date I i <br /> Water System to be TRANSFERED: Amount Paid Date I J <br /> Payment Type Check Number Receiv <br /> REHS: Date ) it J t Account out: Date <br /> COMMENTS: T <br /> VLQ — ill"� t 2erz-t kv� , �g) <br />