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[Rec.ryd <br /> ate yn „N/12014 3:28:32PM SAN JOIN COUNTY ENVIRONMENTAL HEATS DEPARTMENT Report#5021 <br /> t.# <br /> Facility Information as of 6/5/2014 Pagel <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 SSN/Fed Tax ID <br /> Owner ID OW0003305 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 <br /> Home Phone Not Specified n <br /> Work/Business Phone 209-369-4768 Q <br /> Mailing Address PO BOX 440 <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 <br /> Location 6100 E HWY 12 <br /> LODI, CA 95240 <br /> Phone 209-369-4768 <br /> Mailing Address PO BOX 440 <br /> LODI, CA 95241 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 04912034 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 AR0016271 New Account ID: <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 /> Pro rano Element and Description Transfer to ActiveMactve <br /> 9 P Record ID Employee ID and Name 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 PRO518955 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513739 EE0001422-ARTS VELOSO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511559 EE0000000-HAZ MAT SJC OES Inactivc Y N A I D <br /> 2226-CaIARP PROGRAM PR0514550 EE0000000-HAZ MAT SJC CES Inactivc Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0501432 EE0004636-GARRETT BACKUS Inactivc Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509271 EE0000000-HAZ MAT SJC OES Inactivc Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533115 Inactive 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,PHVEHD 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 andtor Standards and State an Dor <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 Ty a Check Number Received by <br /> REHS: {C E li jjU i� Date _/ / J Account out: Date <br /> COMMENTT�^ <br />