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by D8 2/77/2015 :55:a3AA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report R5o2f <br /> Run by <br /> Facility Information as of 2/17/2015 Pegel <br /> Remrd Selectlon Cdteda: Facility to FA0005381 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) —_ <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 OWNERSHIP CHANGE(date) <br /> Owner IDSSN/Fed Tax ID <br /> OW0004224 New Owner ID <br /> Owner Name J LOMBARDI FARMS <br /> Owner DBA J LOMBARDI FARMS <br /> OwnerAddress 16998 E GAWNE RD <br /> STOCKTON, CA 95215 <br /> Home Phone 209-649-0017 <br /> Work/Business Phone 209-948-1909 <br /> Mailing Address 16998 E GAWNE RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0005381 10181815 <br /> Facility Name J LOMBARDI FARMS <br /> Location 29665 KASSON RD <br /> TRACY, CA 95376 <br /> Phone 209-948-1964 <br /> Mailing Address 16998 E GAWNE RD <br /> Care of <br /> STOCKTON, CA 95215I� <br /> Location Code 99- UNINCORPORATED.4 Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 25527052 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Time <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005843 New Account ID: <br /> Mail Invoices to Owner Mall Invoices to: Owner / Facility / Account <br /> Account Name J LOMBARDI FARMS (Circle One) <br /> Account Balance as of 2/17/2015: $292.00 <br /> (Circle One) <br /> PmgranvElement and DescriptionTransfer to Active/Inadve <br /> RecoN ID Employee ID and Name ��•� Status New Owner! Delete <br /> 19'8- <br /> HM-Far operations PR0525844 EE0002474- I Active Y N A �/J/.�( D <br /> 222U- M HW GEN 15 TS/ <br /> ONYR PRO529364 EE0009001 -ELE A MANZO Active Y N Af('J D <br /> ITY-obsolete PR0502269 EE0000451 - Inactive Y N A D <br /> 2830-AST FAC -SPCC EXEMPT PRO529363 EE0009001 -ELENA MANZO Active Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531371 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of some,acknowledge that all site,andor project specific,PHSEHD 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 alt applicable Ordinance Codes andor Standards and state ands <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date 4 — / 131 <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 b <br /> RENS: rt-1 / <br /> COMMENTS: Date,_/�/ Account out: _ Date_ //L_/�� <br /> P sc 77R«p A-a,4sC A-,a- -7Z5:� iZ� Q <br /> d✓e` � q A16,1 Zoirf, . neo f G- fit c.C. <br />