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Date run 3/14/2011 9:36:07Ah SAN JOAPT TIN COUNTY ENVIRONMENTAL HEALTzi DEPARTMENT Report <br /> Run by 55290 %M.01 Pagel <br /> Facility Information as of 3/141201"0- <br /> Record Selection Criteria: Facility 1D FA0017357 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner ID OW0014198 New Owner ID <br /> Owner Name R A KEARSLEY& SON INC <br /> Owner DBA RA KEARSLEY&SON INC <br /> Owner Address 18516 S ALBA RD <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 18516 S ALBA RD <br /> ESCALON, CA 95320 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017357 <br /> Facility Name R A KEARSLEY& SON INC <br /> Location 29640 E VINE AVE <br /> ESCALON, CA 95320 <br /> Phone 209-838-2907 x0 <br /> Mailing Address 18516 S ALBA RD n <br /> ESCALON, CA 95320 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0030239 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner I Facility I Account <br /> Account Name R A KEARSLEY& SON INC (Circle One) <br /> Account Balance as of 311412011: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> ProgramfElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILFIR0525542 Inactive Y N <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO530124 EE0000753-W ILLY NG _ Active,Exempt _ Y _N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0534514 Inactive Y N A <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: Amount Paid Date I I <br /> Payment Type Check Number Receive <br /> REHS: Date 1 1 Account out: Date 1_ l <br /> COMMENTS: <br /> Ileh-envlenvisionlreports15021.rpt <br />