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Date run 11/13/2017 9:52:52A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> .?on by DONNA Pagel <br /> Facility Information as of 11/13/2017 <br /> Record Selection Criteria: Facility ID FA0016696 <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 OW0013537 New Owner ID <br /> Owner Name G RATTO FARMS <br /> Owner DBA G RATTO FARMS <br /> OwnerAddress 537 YETTNER RD <br /> FRENCH CAMP, CA 95231 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-983-8537 <br /> Mailing Address 14350 S JACK TONE RD <br /> MANTECA, CA 95336 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FAD016696 10185255 <br /> Facility Name G RATTO FARMS <br /> Location 537 YETTNER RD <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-982-5686 x0 <br /> Mailing Address 14350 S JACK TONE RD <br /> MANTECA, CA 95336 <br /> Care of G. RATTO Company <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 19306005 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029578 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name G RATTO & CO (Circle One) <br /> Account Balance as of 11/13/2017196 l /S eve.. <br /> \ I Zai 8r <br /> (Give¢One) <br /> Transfer to Aclive/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner aDelete <br /> 1958-HM-Farm Operations PR0524881 EE0002670-MUNIAPPA NAIDU Active Y N A 4=� D <br /> 2830-AST FAC -SPCC EXEMPT PRO530599 EE0001459-VICKI MCCARTNEY Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0533105 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ani project speck,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 Ordnance codes andror Standards and Stale and'or <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 Ri <br /> EHD Staff: Date / /—M Account out: L Date L <br /> COMMENTS: <br /> Invoice#: <br /> u �u� rtPc 1Y1V0��� 1Y tco-�eS (10� <br /> in o fema tbn/ -please 0'lA\ tSe <br />