Laserfiche WebLink
Date nm 2/19/2014 10:22:40AI SAN JO JIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 2/19/2014 <br />Record Selection Criteria: Facility ID FA0016987 <br />OWNER FILE INFORMATION <br />Owner ID OW0013828 <br />Owner Name <br />J DELCARLO FARMS <br />Owner DBA <br />J DELCARLO FARMS <br />Owner Address <br />835 W MARIPOSA AVE <br />STOCKTON, CA 95204 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />835 W MARIPOSA AVE <br />Care of <br />STOCKTON, CA 95204 <br />Care of <br />99 - UNINCORPORATED P <br />FACILITY FILE INFORMATION <br />Facility ID/CERSID <br />FA0016987 10,185,719 <br />Facility Name <br />J DELCARLO FARMS <br />Location <br />11751 SWING LEVEE RD <br />STOCKTON, CA 95206 <br />Phone <br />209-467-3196 x0 <br />Mailing Address <br />835 W MARIPOSA AVE <br />STOCKTON, CA 95204 <br />Care of <br />Location Code <br />99 - UNINCORPORATED P <br />Bos District <br />003 - BESTOLARIDES <br />APN <br />18921006 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) eo <br />�t <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0029869 1 - <br />Mail Invoices to Owner' <br />�/ r Mail Invoices to: <br />Account Name J DELC,j[i -FARMS r'1 ) I <br />Account Balance as of 2/19/2014;"$266:0 1 <br />Program/Element and Description <br />Record ID Employee ID and Name <br />New Account ID: : <br />Owner / Facility <br />(Circle One) <br />Transfer to <br />Status New Owner? <br />Account <br />(Circle One) <br />Active/Inactve <br />Delete <br />1958 - HM -Farm Operations PR0525172 Active Y N A D <br />2220 - SM HW GEN <5 TONS/YR PR0530886 EE0002646 - THUY TRAN Active Y N A D- <br />2830 - AST FAC - SPCC EXEMPT PR0530885 EE0002646 - THUY TRAN Active,I Y N A D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PRO531772 Inactive Y N A 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 andor <br />Federal Laws. <br />APPLICANTS SIGNATURE: -?I rc C�� !-1� 1/I n�- Date / / <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Tie Check Number ReceiVd by <br />REHS: c/ Date / / Account out: Date / / <br />COMMENTS: \ <br />