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Aaterun ' 2/10/2015 2:11:39PR SAN JO�JIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/10/2015 <br /> Record Selection Criteria: Facility ID FA0000151 <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 OW0000128 New Owner ID <br /> Owner Name Ensher, Alexander Barsoom, Inc. <br /> Owner DBA ENSHER, ALEXANDER & BARSOOM <br /> Owner Address 530 BERCUT DR D <br /> SACRAMENTO, CA 958140101 <br /> Home Phone 916-443-6875 <br /> Work/Business Phone 916-417-8205 <br /> Mailing Address PO Box 1044 <br /> Walnut Grove, CA 95690 <br /> Care of ENSHER, ALEXANDER & BARSOOM <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0000151 -e4TrTn_ <br /> Facility Name Stockton Ranch <br /> Location 14125 HWY 4 <br /> Stockton, CA 95206 <br /> Phone 916-417-8205 x <br /> Mailing Address PO BOX 1044 <br /> Walnut Grove, CA 95690 <br /> Care of Jim Barsoom <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOIS District 003- BESTOLARIDES, STEVE Fax <br /> APN 12920012 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION _ <br /> Account lD AR0000150 .� . rt_V/I /n p �J I n / New Account ID: <br /> Mail Invoices to Account I ' Y{O�f�I ` O,CI J1�ail Invoices to: Owner / Facility / Account <br /> Account Name JI rSOOm I ,_ f/✓ y �J"n t-1/ (circa one) <br /> Account Balance as of 2/10 015: $292.00 <br /> (Circle One) <br /> Transfer to Active/Inact e <br /> Program/Element and Description Record ID mploy"ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations mDV J PRO638329 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> • 2220-SM HW GEN<5 TONS/YR PRO538328 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2755-EMPLOYEE HOUSING-SEASONAL<l80 DAYS PR0270095 EE0002089-OMRAN SOOD , J Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO538330 EE0001421 -STACY RIVERA v Clive Y N A I D <br /> 4634-TNC WATER SYSTEM(QRTLY) WA0461355 EE0005838-ADRIENNE ELLSAESSER Active, Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor 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. 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes ander Standards and State andor <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 �T Check Number Received by _ <br /> REHS: �AiN Date_ /Sl / t Account out: Date /_L2__/ /J <br /> COMMENTS: <br /> [Olj93 -To IFA00 Will"4 <br />