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Date run 2/23/2015 10:39:34AI SAN J( UIN COUNTY ENVIRONMENTAL HE,& I DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/23/2015 <br /> Record Selection Criteria: Facility ID FA0009941 <br /> Make changes/corrections in RED ink. 1� _n� <br /> INFORMATION CHANGE(date) ,3141 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0007941 Case Number: H05938 New Owner ID <br /> Owner Name RON & DEANNA GOEHRING <br /> Owner DBA GOEHRING PUMP & IRRIGATION <br /> Owner Address 17754 N HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-727-5548 <br /> Mailing Address PO BOX 113 <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009941 10183047 <br /> Facility Name GOEHRING PUMP & IRRIGATION <br /> Location 17754 N HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Phone 209-727-5548 x <br /> Mailing Address PO BOX 113 <br /> LOCKEFORD, CA 95237 <br /> Care of Ron Goehring <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 05125010 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 AR0016941 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name GOEHRING PU IR GATION (Circle One) <br /> Account Balance as of 2/23/2015: $57 . 0 vov <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519976 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514103 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512229 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2333-FARM UST#1 FACILITY-obsolete PR0501799 EE0000005-FATINAH ZAREEF InactivE Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509941 EE0000000-HAZ MAT SJC OES InactivE Y N A I D <br /> 83 � AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0535643 EE0001422-ARIS VELOSO Active Y N A (1 D <br /> ERSC <br /> -ELECTRONIC REPORTING STATE SURCHARG PR0531999 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 or <br /> be billed t�thAe 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 and/or 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 Received by <br /> REHS: \�Y 1FJe/Urll Date /�/ ' Account out: _ Date / —7'�5/ <br /> COMMENTS: <br />