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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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EHD Program Facility Records by Street Name
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JACOB BRACK
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18667
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2900 - Site Mitigation Program
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PR0528324
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SITE INFORMATION AND CORRESPONDENCE
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Entry Properties
Last modified
2/6/2020 3:08:06 PM
Creation date
2/6/2020 9:11:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0528324
PE
2965
FACILITY_ID
FA0019131
FACILITY_NAME
SUTTER HOME LODI WINERY
STREET_NUMBER
18667
STREET_NAME
JACOB BRACK
STREET_TYPE
RD
City
LODI
Zip
95242
APN
01109014
CURRENT_STATUS
01
SITE_LOCATION
18667 JACOB BRACK RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
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EHD - Public
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Date run 7/19/2013 10:54:10AI SAN JG IN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 7/19/2013 <br /> Record Selection Criteria: Facility ID FA0019131 <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 OW0009663 New Owner ID <br /> Owner Name SUTTER HOME WINERY INC <br /> Owner DBA <br /> Owner Address PO BOX 248 <br /> ST HELENA, CA 945740248 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 100 MAIN ST HWY SO <br /> ST HELENA, CA 94574 <br /> Care of C/O AL SULLIVAN <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019131 <br /> Facility Name SUTTER HOME LODI WINERY <br /> Location 18667 JACOB BRACK RD <br /> LODI, CA 95242 <br /> Phone 209-365-0370 <br /> Mailing Address PO BOX 248 <br /> ST HELENA, CA 945740248 <br /> Care of <br /> Location Code 99-UNINCORPORATED P Alt Phone <br /> BOIS District 004 -VOGEL, KEN Fax <br /> APN 01109014 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 AR0034068 New Account to: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SUTTER HOME LODI WINERY (Circle One) <br /> Account Balance as of 7/19/2013: $-375.00 <br /> (Circle One) <br /> Transfer to ActiveAnscb,e <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2965-WATER QUALITY SITE PROJECT PRO528324 EE0000997-HARLIN KNOLL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,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 ba billed to the party Identified as the OWNER on this font I also rarity that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State arctic, <br /> Federal laws. <br /> APPLICANTS 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: Date / / Account out: Date <br /> COMMENTS: <br />
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