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Date run 2/10/2015 2:11:39PR SAN JO 'JIM COUNTY ENVIRONMENTAL HEA- ' DEPARTMENT Report#5021 <br /> Run by "o Pagel <br /> Facility Information as of 2/10/2015 <br /> Record Selection Criteria: Facility ID FA0000151 <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: 1 SSN/Fed Tax ID <br /> Owner ID OW0000128 New Owner ID <br /> Owner Name Ensher, Alexander Barsoom, Inc. <br /> Owner DBA ENSHER, ALEXANDER & BARSOOM <br /> Owner Address 530 BERCUT DR D <br /> SACRAMENTO, CA 958140101 <br /> Home Phone 916-443-6875 <br /> Work/Business Phone 916-417-8205 <br /> Mailing Address PO Box 1044 <br /> Walnut Grove, CA 95690 <br /> Care of ENSHER, ALEXANDER & BARSOOM <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0000151 <br /> Facility Name Stockton Ranch <br /> Location 14125 HWY 4 <br /> Stockton, CA 95206 <br /> Phone 916-417-8205 x <br /> Mailing Address PO Box 1044 <br /> Walnut Grove, CA 95690 <br /> Care of Jim Barsoom <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 12920012 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 AR0000150 /� /JL/ ( New Account ID: <br /> Mail Invoices to Account Pf <br /> ailInvoices to: Owner / Facility / Account <br /> Account Name JI arsoom DO (Circle One) <br /> Account Balance as of 2/10 015: $292.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record IDtMiployee ID and Name Status New OwneR Delete <br /> 1958-HM-Farm Operations rrn"u V f PR0538329 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR mph{y�� PR0538328 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2755-EMPLOYEE HOUSING-SEASONAL<180 DAYS PR0270095 EE0002089-OMRAN SOOD Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0538330 EE0001421 -STACY RIVERA /"V ctive Y N A I D <br /> 4634-TNC WATER SYSTEM(QRTLY) WA0461355 EE0005838-ADRIENNE ELLSAESSER Active, 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 project specific,PHS/EHD 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 and/or Standards and State and/or <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 Type Check Number Received by <br /> REHS: Date Account out: Date / 2— <br /> COMMENTS: <br /> COMMENTS: C <br /> I�J i L1NV-k-_O >r(}'* , µ.ova 4— mef-�e CxA P <br /> l�9 3 p r s .�b 1FA00 lb"14 , <br /> Cf : L.-M VT Lf <br />