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[Record <br /> ale um ...x3!$/2014 3:29:19PM SAN JCOUIN COUNTY ENVIRONMENTAL HEAVY DEPARTMENT <br /> ud by �,II ::Repon!#5021 <br /> Facility Information as of 6/5/2014 agel <br /> Selection Criteria: Facility ID FA0009271 <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: 3 <br /> SSN/Fed Tax ID <br /> Owner ID OW0003305 <br /> New Owner ID <br /> Owner Name OAK RIDGE WINERY LLC <br /> owner DBA OAK RIDGE WINERY LLC <br /> Owner Address 6100 E HWY 12 <br /> LODI, CA 95240 U <br /> Home Phone Not Specified / <br /> Work/Business Phone 209-369-4758 ('/�(!q)-JIOq—q-7/&g ✓ / — <br /> Mailing Address PO BOX 440 l <br /> LODI, CA 95241 <br /> Care of <br /> FACILITY FILE INFORMATION / <br /> Facility lD/CERS ID FA0009271 10182555 (\/ <br /> Facility Name OAK RIDGE WINERY, LLC C\ <br /> Location IFt 00 <br /> LODI, CA 95240 <br /> Phone 209-369-4768 x <br /> Mailing Address PO BOX 440 <br /> LODI, CA 95241 <br /> Care of Rudy Maggio <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 04912034 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016271/ <br /> ✓ New Account lD: ; <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name OAK RIDGE WINERY, LLC (Circle One) <br /> Account Balance as of 6/5/2014: $0.00 <br /> (Circle One) <br /> Pmgram/Element and Description Record ID Employee ID and NameTransfer to Activednactve <br /> Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO520357 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 1962-CaIARP PROGRAM 2 FACILITY PRO535193 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 1995-CaIARP FAC STATE SURCHARGE FEE PR0518955 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO513739 EE0001422-ARIS VELOSO Active Y N A 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511559 EE0000000-HAZ MAT SJC OES Inactive Y N A <br /> 2226-CaIARP PROGRAM I D <br /> 2381 PR0514550 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> -UST FACILITY(BEFORE 1/84)-obsolete PR0501432 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509271 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533115 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,i ndbr project specific,PHSIEHD 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 accord with all applicable Ordinance Codes anNor standards end State and/or <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Typq �hecl- Number Received by <br /> REHS: �<I 11�/ Date / ! Account out: Date <br /> COMMENTS: <br />