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Date run 3/1/2013 1:18:56PM SAN JOIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report#5021 <br /> Run by Pagel <br /> _ Facility Information as of 3/112013 <br /> Record Selection Criteria: Facility ID FA0016786 <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 OW0013627 New Owner ID <br /> Owner Name DUANE MARTIN LIVESTOCK <br /> Owner DBA DUANE MARTIN LIVESTOCK <br /> Owner Address 2021 E HWY 88 RD <br /> [ONE, CA 95640 <br /> Home Phone Not Specified <br /> WoWBusiness Phone Not Specified <br /> Mailing Address 2021 E HWY 88 RD <br /> ZONE, CA 95640 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016786 <br /> Facility Name DUANE MARTIN LIVESTOCK <br /> Location 0 NE WAVERLY& COPPEROPOLIS RD <br /> FARMINGTON, CA 95230 <br /> Phone 209-274-6411 x0 <br /> Mailing Address 2021 E HWY 88 RD <br /> IONE, CA 95640 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 09340001 Eli <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029668 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name DUANE MARTIN LIVESTOCK (Circle One) <br /> Account Balance as of 3/1/2013: $0.00 <br /> (Circle One) <br /> Transfer to ActivWlnactve <br /> PrograMElemenl and Description Record ID Employee 10 and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0524971 Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCRPR0533498 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,atlmowledge that all site,andor project speoRc,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party,identRed as the OWNER on this form l also certgy that all operations will be performed in accordance with all applicable Ordinance Cortes and/or Standards and State and/or <br /> Federal Lewis <br /> t I No lo^x<- � PAs Mao di Lam- prrrP� <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 a Check Number Receiv <br /> REHS: �(gCT(�!)'1 I(�� Date�/ —I —/—L3— Account out: Date <br /> COMMENTS: 1 <br />