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Date run 2/11/2014 9:07:10AR SAN J UIN COUNTY ENVMONMENTAL HEA01 DEPARTMENT Report#5021 <br /> Run by 127�3 Pagel <br /> Facility Information as of 2/11/2014 <br /> Record Selection Criteria: Facility ID FA0017025 <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 OW0013866 New Owner ID <br /> Owner Name C&G FARMS <br /> Owner DBA C&G FARMS <br /> Owner Address 3458 W LINNE RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> workBusiness Phone Not Specified <br /> Mailing Address 3458 W LINNE RD 1 -77Z «L/Nl•!E kP <br /> TRACY, CA 95304``3c;q 15 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017025 10,185,775 <br /> Facility Name C&G FARMS <br /> Location 1777 W LINNE RD <br /> TRACY, CA 95304 <br /> Phone 209-835-2412 x0 <br /> Mailing Address 3458 W LINNE RD 77 7 / hln1F_ <br /> TRACY, CA 95304" <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> Bos District 005 - ELLIOTT, BOB Fax <br /> APN 23922010 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 AR0029907 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name C&G FARMS (Circle One) <br /> Account Balance as of 2/11/2014: $266.00 <br /> (Circle One) <br /> Transfer to Activednachie <br /> PrograMElement and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1958-HM-Farm Operations PR0525210 Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0529361 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO529360 EE0009001 -ELENA MANZO Active,I Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534534 Inactivc Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD hourfy 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 ander <br /> Federal L. <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 Type Check Number Recei <br /> RENS: Date_/ / Account <br /> out: Date / / �� <br /> COMMENTS: <br />