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Date run 11/21/2013 2:25:33P SAN JON COUNTY ENVIRONMENTAL.HEA EPARTMENT Report#5021 <br /> Run by 0 Pagel <br /> Facility Information as of 11121/2013 <br /> Record Selection Criteria: Facility ID FA0017183 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) t <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner ID OW0014024 New Owner ID <br /> Owner Name RUTLEDGE RANCH <br /> Owner DBA RUTLEDGE RANCH <br /> Owner Address 1643 E WOODBRIDGE RD <br /> WOODBRIDGE, CA 95258 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1643 E WOODBRIDGE RD <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0017183 10,186,033 <br /> Facility Name ,RUTLEDGE RANCH <br /> Location 1643 E WOODBRIDGE RD <br /> WOODBRIDGE, CA 95258 <br /> Phone 209-369-5043 x0 <br /> Mailing Address 1643 E WOODBRIDGE RD <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL. KEN Fax <br /> APN 01318019 EMaii: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030065 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name RUTLEDGE RANCH (Circle One) <br /> Account Balance as of 11121!2013: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525368 Active Y N Ar D <br /> 2840-AST EXEMPT FAC a 1,320 GAL PRO529626 EE0000753-WILLY NG Active,! Y N A tI D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531652 Inactiv€ Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and'or proyect 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 accordance with all applicable Ordinance Codes andler Standards and State and/or <br /> F dWw " <br /> L117,�1f3 <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date / 1 <br /> Payment Type Check Number Rec by <br /> RENS: Date Z1 122 Account out: Date 1 <br /> CO 1MEN 0\�cO_C S ar <br />