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Dale run ` 3111/2013 10:35:29AI SAN JOA ,N COUNTY ENVIRONMENTAL HEAL' EPARTMENT Report#5021 <br /> `I Pagel <br /> Run by Facility Information as of 3/11/201 <br /> Record Selection Criteria: Fa ili ID FA0017399 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014240 New Owner ID <br /> Owner Name HALL NUT FARMS <br /> Owner DBA HALL NUT FARMS <br /> Owner Address 29322 E HALL RD <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 29322 HALL RD RD <br /> ESCALON, CA 953209630 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017399 <br /> Facility Name HALL NUT FARMS <br /> Location 29322 E HALL RD <br /> ESCALON, CA 95320 <br /> Phone 209-487-5181 x0 <br /> Mailing Address 29322 HALL RD RD 259 W Njci I G��7 S �5 <br /> ESCALON, CA 953209630 5z67 — 1"710 <br /> Care of ifi nil.S F}La GrOP — Mljj S,Sw Ardhl/x� <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 24724010 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 AR0030281 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name HALL NUT FARMS (Circle One) <br /> Account Balance as of 3/11/2013: $53.00 <br /> (Circle One) <br /> Transfer to Activialni <br /> Progra"Element and Description Record ID Employee ID and Name Status New Ovmi Delete <br /> 1958-HM-Fane Operations PRO525584 Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529960 EE0000753-WILLY NG Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PRO533639 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specft,PHS/EHD hourly charges associated with this facility <br /> or activity will W billed to Ne party ideni as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes all Standards and State ands <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 Received by <br /> RENS: Date_/ / Account out: Date <br /> COMMENTS: / <br />