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Date run 4/6/2015 10:32 36AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/6/2015 <br /> Record Selection Criteria: Facility ID FA0022843 <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 OW0020791 New Owner ID <br /> Owner Name BV FARMS, LLC <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-578-5800 <br /> Mailing Address 515 LYELL DR. SUITE 101 <br /> MODESTO, CA 95356 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FAD022843 10416676 <br /> Facility Name BV FARMS, LLC <br /> Location 27299 HWY 120 <br /> Escalon, CA 95320 <br /> Phone 209-578-5800 x <br /> Mailing Address 515 LYELL DR. SUITE 101 <br /> MODESTO, CA 95356 <br /> Care of ROBERT VAN SPRONSEN <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0041906 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner ! Facility I Account <br /> Account Name BV FARMS, LLC (Circle One) <br /> Account Balance as of 41612015: $0.00 <br /> (Circle One) <br /> Transfer to Activefinactve <br /> Program/Element and Description Record In Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations P'RO539948 EE0002474-MICHAEL PARISSi Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific,P ISLE ID 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 andlor Standards and State and/or <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 ! 1 <br /> Payment Type Check Number Received by r <br /> REHS: _ Date kccount out: Date <br /> COMMENTS: <br />