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Report #5021 <br />Date iun 2'/5/2013 3:47:58PM SAN JIN COUNTY ENVIRONMENTAL HEAWDEPARTMENT Pagel <br />Run by 4 <br />Facility Information as of 2/5/2013 <br />Record Selection Criteria: Facility ID FA0008041 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0006646 <br />Owner Name <br />JOHN TAYLOR FERTILIZERS CO <br />Owner DBA <br />Owner Address <br />PO BOX 15289 <br />SACRAMENTO, CA 958510289 <br />Home Phone <br />916-991-4451 <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />PO BOX 15289 <br />SACRAMENTO, CA 958510289 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0008041 <br />Facility Name <br />JOHN TAYLOR - STOCKTON <br />Location <br />1819 S ARGONAUT ST <br />%2f•fy , <br />STOCKTON, CA 95206 <br />�uTo� Phone <br />209-944-9951 <br />SFR Mailing Address <br />PO BOX 1030 <br />MARYSVILLE, CA 95901 <br />Care of <br />JOHN TAYLOR FERTILIZERS <br />Location Code <br />01-STOCKTON <br />BOS District <br />002 - RUHSTALLER, LARRY <br />APN <br />16320008 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />CAROLYN KNEIBLHER <br />Title <br />Day Phone <br />925-943-3034 <br />Night Phone <br />916-991-9813 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0015121 <br />Mail Invoices to Account <br />Account Name JOHN TAYLOR - STOCKTON <br />Account Balance as of 2/5/2013: $-238.00 <br />Program/Element and Description <br />Record ID Employee ID and Name <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />2960 - RWQCB SITE PR0508343 EE0006219 - LORI DUNCAN Active r Iv A I I_ <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 andlor <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: * $25.00 = <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: Date <br />COMMENTS: <br />Amount Paid _ <br />Amount Paid <br />Date / /. <br />Date <br />Date <br />Received by <br />Account out: Date <br />