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Dbterun 7/2/2014 3:55:54PM SAN JJWIN COUNTY ENVIRONMENTAL HE,* DEPARTMENT <br />Report #5021 <br />Run by Pagel <br />Facility Information as of 7/2/2014 <br />Record Selection Criteria: Facility ID FA0008041 <br />OWNER FILE INFORMATION Number of facilities for this owner: 2 <br />Owner ID <br />OW0006646 <br />Owner Name <br />JOHN TAYLOR FERTILIZERS CO <br />Owner DBA <br />1819 S ARGONAUT ST <br />Owner Address <br />PO BOX 15289 <br />Phone <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 />Location Code <br />SACRAMENTO, CA 958510289 <br />Care of <br />002 - RUHSTALLER, LARRY <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0008041 <br />Facility Name <br />JOHN TAYLOR - STOCKTON <br />Location <br />1819 S ARGONAUT ST <br />STOCKTON, CA 95206 <br />Phone <br />209-944-9951 <br />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 CAROLYN KNEIBLHER <br />Title <br />Day Phone 925-943-3034 <br />Night Phone 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 7/2/2014: $250.00 <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 />Program/Element and Description Record ID Employee ID and N Status New Owner? Delete <br />2960 - RWQCB SITE PR0508343 EE000169 - JOHNNY YOAKUM /I Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowl'6tigalLiaLafl-site..en�orrSroje" ct 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 and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS: <br />* $25.00 = Amount Paid _ <br />Amount Paid <br />Date / / Account out: <br />r/lkt � rcAUX-nI -�>kto.se "\j. s* <br />Date / / <br />Date <br />Date <br />Received by <br />Date <br />I <br />