Laserfiche WebLink
Date run 8/3/2010 8:33:35AM SAN JOA;'-IIN COUNTY ENVIRONMENTAL HEALT" DEPARTMENT Report 95021 <br /> Run b # <br /> Facility Information as of 8131201( Pagel <br /> Record Selection Criteria: Facility ID FA0016482 <br /> IN IL Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner ID OW0008071 Case Number: H06440 New Owner ID <br /> Owner Name RIPON FARM SERVICES <br /> Owner DBA RIPON FARM SERVICE <br /> Owner Address 938 S HWY 99 E FRONTAGE RD <br /> RIPON, CA 953660806 <br /> Home Phone 209-476-8213 <br /> Work/Business Phone 209-599-2188 <br /> Mailing Address PO BOX 806 <br /> RIPON, CA 953660806 <br /> Care of OUDEN, BUD DEN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016482 <br /> Facility Name RIPON FARM SERVICE <br /> Location 932 S HWY 99 E FR RD <br /> RIPON, CA 95366 <br /> Phone 209-599-2188 <br /> Mailing Address PO BOX 806 <br /> RIPON, CA 95366 <br /> Care of <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 005- ORNELLAS, LEROY Fax <br /> APN 26102007111 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title \ S <br /> Day Phone 209-599-2188 Ot <br /> ACCOUNTS RECEIVABLE FILE INFORMATION G 3 660 ' YYUwV(adtd <br /> Account ID AR0029006 � 4�` �, 0.'p �19 _ 1 S� �9 New Account ID: <br /> Mail Invoices to CCOunt CSv1 t "1 Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name ON FARM SERVICE (Circle one) <br /> Account Balance as of 81312010: $954.50 <br /> (Circle One) <br /> Transfer io Activelinactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PR0524571 EE0001459-VICKI MCCARTNEY Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSlEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this Torn. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes andlor Standards and <br /> State andfor Federal Laws. <br /> APPLICANT'S SIGNATURE: S 2 e Ck�Q e�..n,I§ \►Y 0.'\ �e.�.t^c.r� �(��p Date 'i� I Z r 1 O <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date I ! <br /> Water System to be TRANSFERED: `$372.00= Amount Paid Date / 1 <br /> Payment Type Check Number Received by <br /> RENS: Date I 1 Account out: —� lr-- Date "06 I 3 I li, <br /> COMMENTS: <br /> Ileh-env%envisionlreports15021.rpt <br />