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Date run 3/312014 11:34:33AIV SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/3/2014 <br /> Record Selection Criteria: Facility ID FA0016705 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013546 New Owner ID <br /> Owner Name FRANK CANEPA VINEYARD <br /> Owner DBA FRANK CANEPA VINEYARD <br /> Owner Address 15760 N TULLY RD <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> WorkJBusiness Phone Not Specified <br /> Mailing Address 15760 N TULLY RD <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility IDICERS ID FA0016705 10,185,267 <br /> Facility Name FRANK CANEPA VINEYARD <br /> Location 15760 N TULLY RD <br /> LODI, CA 95240 <br /> Phone 209-727-5298 x0 <br /> Mailing Address 15760 N TULLY RD <br /> LODI, CA 95240 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 05308001 FMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029587 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner f Facility 1 Account <br /> Account Name FRANK CANEPA VINEYARD (Circle One) <br /> Account Balance as of 31312014: $53.00 <br /> �b`•' (Circle One) <br /> Transfer to AcliveAfiactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owned Delete <br /> 1958-HM-Farm Operations PR0524890 Active Y N A 0 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532378 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,ancVor project specific,PHSIl 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 andor Standards and State andror <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / 1 <br /> Water System to be TRANSFERED- Amount Paid Date ! f <br /> Paymentypi Check Number Received b <br /> REHS: In.� n Date f f - 1 7 Account out: Date lel] l <br /> COMMENTS: <br /> a. t� &-rJ Uvz i m I o G <br /> KA S . <br />