Laserfiche WebLink
Date run 3/11/2014 8:08:50AN SAN JO iIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 3/11/2014 <br />Record Selection Criteria: Facility ID FA0016997 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0013838 <br />Owner Name <br />etlFF6R-91. LAUCHLAND RANCH <br />Owner DBA <br />CDFFOf�© LAUCHLAND RANCH <br />Owner Address <br />5271 W TURNER RD <br />LODI, CA 95242 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />5271 W. TURNER ST <br />LODI, CA 95242 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0016997 10185733 <br />Facility Name CtFf-GPQ.LAUCHLAND RANCH <br />Location 5271 W TURNER RD <br />LODI, CA 95242 <br />Phone 209-368-1659 x0 <br />Mailing Address 5271 W. TURNER ST <br />LODI, CA 95242 <br />Care of <br />Location Code <br />BOS District <br />APN 01116017 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0029879 <br />Mail Invoices to Owner <br />Account Name CLIFFORD LAUCHLAND RANCH <br />Account Balance as of 3/11/2014: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New nOwner ID : <br />Alt Phone <br />Fax <br />EMail : <br />%ray LAI; chIaua 6a I <br />t <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1958 - HM -Farm Operations PR0525182 Active Y N A I D <br />2830 - AST FAC - SPCC EXEMPT PR0530448 EE0001422 - ARIS CACAPIT Active,l Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0531982 Inactive Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andror project specific, PHSIEHD hourly charges associated with this facility or <br />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 andror 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 Recely <br />REHS:> _ Date_Account out: Date <br />COMMENTS: <br />