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Date run 2/25/2016 11:52:08AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 2/25/2016 <br />Record Selection Criteria: Facility ID FA0017519 <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 <br />SSN /Fed Tax ID <br />Owner ID <br />OW0014360 <br />New Owner ID <br />Owner Name <br />RONALD T OYE <br />Owner DBA <br />RONALD T OYE <br />Owner Address <br />6545 E LIVE OAK RD <br />LODI, CA 95240 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-369-6233 <br />Mailing Address <br />PO -$1944-7A& <br />t, <br />GAT,�� <br />o a�'r G A �I -ago <br />- a <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0017519 10186579 <br />Facility Name <br />RONALD T OYE <br />Location <br />6545 E LIVE OAK RD <br />LODI, CA 95240 <br />Phone <br />209-369-6233 x0 <br />Mailing Address <br />poe-Bf�- q,4(7„ 4 <br />G L <br />n r T G n 96632 \ �— <br />t <br />O -C7 YPL-K <br />Care of <br />Ronald T Oye <br />Location Code <br />Alt Phone <br />BOS District <br />Fax <br />APN <br />06116005 <br />EMail: <br />EMERGENCY NOTIFICATION CONTACT INFORM, <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0030401 <br />Mail Invoices to Account <br />Account Name RONALD T OYE <br />Account Balance as of 2/25/2016: $53.00 <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1958 - HM -Farm Operations PR0525704 EE0002670 - MUNIAPPA NAIDU Active Y N A I D <br />2840 - AST EXEMPT FAC < 1,320 GAL PR0530453 EE0000753 - WILLY NG Inactive Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0533121 Inactive Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or 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. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State andlor <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS: <br />Date <br />' $25.00 = Amount Paid Date <br />Amount Paid Date <br />Date <br />Received by -457 <br />Account out: Date <br />Invoice #: <br />(.VlC-ab2 Ve\a`.\ \tJS cc d 1-( s a s F e ✓' re�'Jr") VV\C <br />