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Date run 10/14/2019 12:38:011' SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/14/2019 <br /> Record Selection Criteria: Facility ID FA0024549 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0023133 New Owner ID <br /> Owner Name VALLEY MILK LLC <br /> Owner DBA <br /> Owner Address 400 N WASHINGTON RD <br /> TURLOCK, CA 95380 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 209-410-6701 <br /> Mailing Address 400 N WASHINGTON RD <br /> TURLOCK, CA 95380 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0024549 <br /> Facility Name VALLEY MILK LLC <br /> Location 400 N WASHINGTON RD <br /> TURLOCK, CA 95380 <br /> Phone 209-410-6701 <br /> Mailing Address PO BO 39 AJ <br /> TU CK, CA 95381 ,1/��(OLK-� 3�U <br /> Care of <br /> Location Code 98 - OUT OF COUNTY Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name VALLEY MILK LLC <br /> Title <br /> Day Phone 209-410-6701 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0045858 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VALLEY MILK LLC (Circle One) <br /> Account Balance as of 10/14/2019: $1,707.76 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2012-GRADE A MILK PROCESSOR PR0542670 EE0005362-NICHOLAS WIESEMAN 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 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: 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 /> EHD Staff: Date / / Account out: Date l I l <br /> COMMENTS: <br /> Invoice#: <br /> /Zo <br /> mom- vLu 1it-K. <br />