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Date rur- /2010 2:59:05PK SAN JO,,' -UIN COUNTY ENVIRONMENTAL HEAI"q DEPARTMENT Report#5021 <br /> Run by 1273 Facility Information as of 2/11/20 Pagel <br /> Record Selection Criteria: Facility ID FA0019821 <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 OW0016264 New Owner ID <br /> Owner Name PHIPPEN BROTHERS LP <br /> Owner DBA <br /> Owner Address 13909 LEROY AVE <br /> RIPON, CA 95366 <br /> Home Phone 209-531-7380 <br /> Work/Business Phone Not Specified <br /> Mailing Address 13909 LEROY AVE <br /> RIPON, CA 95366 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019821 <br /> Facility Name PHIPPEN BROTHERS LP <br /> Location 18557 S MURPHY RD <br /> LATHROP, CA 95330 <br /> Phone 209-531-7380 <br /> Mailing Address 18557 S MURPHY RD 3 <br /> LATHROP, CA 95330 1 p� <br /> Care of <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 24504007 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035284 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name PHIPPEN BROTHERS LP (Circle One) <br /> Account Balance as of 2/11/2010: $262.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0530290 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0530289 EE0002670-MUNIAPPA NAIDU Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0532402 Active Y N A I 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 <br /> facility 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 Ordinace Codes and/or standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date ! / <br /> Payment Type Check Number Receive <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />