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i <br /> Date tui 3/1712015 B:49:15AA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Reppn 45021Run b <br /> Facility Information as Of 3/17/2015 Pac" <br /> ..d Sapcapn Cmana. I'Wity 10 FA0005802 <br /> Make changeslcorroctions in RED ink. <br /> O INF9RI0aTION CHANGE(date) <br /> NERSHIP CHANGE(tlate) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSNl Fad TaxlD - Gj u2 <br /> Owner to OW0004612 wnert <br /> Owner Name ABERLE ACRES INC 7 5 <br /> Owner DBA ABERLE ACRES INC 39-80 <br /> Owner Address 19750 N LOWER SACRAMENTO <br /> ACAMPO, CA 95220 <br /> Home Phone Not Specified —14..7--7, U, <br /> CC 4 <br /> Work/Business Phone Not Specified <br /> Mailing Address 19750 N LOWER SACRAMENTO RD <br /> ACAMPO, CA 95220 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility IDICERSID FA0005802 10181937 <br /> Facility Name ABERLE ACRES INC 39-80 OY+YI FD i' 1 <br /> Location 19750 N LOWER SACRAMENTO RD —� <br /> ACAMPO, CA 95220 <br /> Phone 000-000-0000 <br /> Mailing Address PO BOX 1025 `J O(/) HQMlYtC'+,- <br /> WOODBRIDGE, CA 95258 A U 1S < C16�56Y <br /> Care of ABERLE ACRES INC <br /> Location Code 99-UNINCORPORATED P AR Phone <br /> BOS District 004-WINN,CHARLES Fax <br /> APN 01318050 Eli ll: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> TIIIe <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0006598 New Account 10: <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility / Account <br /> Account Name ABERLE ACRES INC 39-80 (cxae Dna) <br /> Account Balance as of 3/17/2015: $292.00 <br /> tcimae oro) <br /> TrDa <br /> w0 W ACplladNe <br /> PmgreMEme <br /> anl.rMaec <br /> o4pdpn RocwdlD Empbyee to roll Nam SIWs <br /> New OvmM DeKte <br /> 1958-HM-Farm Operations PRO525937 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO530424 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2795-EMPLOYEE HOUSING-HISTORICAL CAMPS PRO503366 EE0002646-THUY TRAN Inactive Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO530423 EE0001422-ARIS VELOSO Active Y N A i D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533400 Inactive V N A I D <br /> ■UINGand CDMNLIANCEACNNOWLEDGEMENT. Lawuada W vperaloemnaanlWaane...a,lledaennalula.ands aolvcl aPvulic,PH&EMD dourly<napea pssxa<dwaN tms laalay <br /> aada",lin'W ild'adtp livaW danofiedialne OWNER ISu lwm lalao lr tyNn all winanans will h,muormne in iaad ice xhnr all applicable Of4 l=Coaat rSbl rdsa SUIean6r <br /> /raaaaa Law. <br /> (:APPLICANTS ILCANT'S SIGNATUREDete ! ' 7/ �� <br /> Program Records to be 7RANSFERED: _.$2600. <br /> $2500 Amount Paid Data <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number RecelviLd by �� <br /> RENS: Date_I—l_ Account out: «� Date 3 1�_I_y2_- <br /> COMMENTS: <br /> XYZ = /VLL-L " i <br />