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Date run 12/18/2006 1:33:53P SAN JO: "JIN COUNTY ENVIRONMENTAL HEAL— DEPARTMENT Report#5021 <br /> Run by 4006 Facility Information as of 12/18/201, Pagel <br /> Record Selection Criteria: Facility ID FA0016482 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <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 All ti P&Afe vs <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 L U <br /> Mailing Address 938 FRONTAGE RD <br /> RIPON, CA 95366 <br /> Care of <br /> Location Code APN:26102007/11 <br /> BOS District 005-ORNELLAS, LEROY SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029006 New Account ID: <br /> �AccountMail Invoices to Mail Invoices to: Owner / <br /> Account Name ISOLA AND ASSOCIATES LLP (Circle One) <br /> Account Balance as of 12/18/2006: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <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,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: "$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: L .tnnnat.>t.s,� Date / / Account out: Zr- Date 12-4 JL_0� <br /> COMMENTS: <br /> t\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />