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Date run 8114/2014 4:18:20PR SAN JO,111111UIN COUNTY ENVIRONMENTAL HEA4,lilli DEPARTMENT Report*5021 <br /> Run by Pagel <br /> Facility Information as of 8114/2014 <br /> Record Selection Criteria, Facility ID FACO22512 <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 1 Fed Tax ID <br /> Owner ID OW0020034 New Owner ID <br /> Owner Name Bruce & Helen Towne <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 916-776-1424 <br /> Mailing Address P.O. Box 185 <br /> Walnut Grove, CA 95690 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0022512 10451758 <br /> Facility Name New Hope Ranch <br /> Location 13550 W Lauffer Rd <br /> Thornton, CA 95686 <br /> Phone 916-776-1424 x <br /> Mailing Address P.O. Box 185 <br /> Walnut Grove, CA 95690 <br /> Care of Towne Enterprises <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 001-03-011 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 AR0041 192 New Account ID: <br /> Mall Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name New Hope Ranch (Circle one) <br /> Account Balance as of 8/14/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activellr ive <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO539377 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anchor project specific,PHSlEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. E also certify that all operations will be performed in accordance with all applicable Ordinance Codes.anti Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 <br /> Water System to be TRANSFERED: Amount Paid Date I <br /> Payment Type Check Number Recei y <br /> REHS: Date ! ! tAccount out: Date i 1 <br /> COMMENTS', e <br /> NC,vJ <br />