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w <br /> Ah <br /> Wr <br /> Date run 12/5/2007 3:40:54PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTtI DEPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 12/5/2007 <br /> Record Selection Criteria: Facility ID FA0004385 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0003300 New Owner ID <br /> Owner Name JESSOP, LOREN � *001 <br /> Owner DBA SIERRA ORGANICS <br /> Owner Address 1480 HERITAGE TRAIL ' it C! <br /> CARMARILLO, CA 93012 1114 iidi V_ 4*9I2rrlR IPTO4 3 <br /> Home Phone 209-591-9658 <br /> Work/Business Phone 209-982-4936 <br /> Mailing Address PO BOX 31750 ri �'{ le✓ �� '� 1�fd� <br /> STOCKTON, CA 95213 <br /> Care of 4pawty l/ 0*0* ffou <br /> FACILITY FILE INFORMATION <br /> Fw� 19 71 <br /> Facility ID FA0004385 <br /> Facility Name SIERRA ORGANICS '5*yw&r <br /> Location 4343 S MCKINLEY AVE <br /> STOCKTON, CA 95206 <br /> Phone 209-982-4936 y'l 3 mszeAot oy <br /> Mailing Address PO BOX 18670 �fOnl « tr ` <br /> PHOENIX, AZ 850058670 O • <br /> Care of LOREN JESSOP a VIA FloCom& <br /> Location Code 99 - UNINCORPORATED AREA APN:19302009 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004067 hrF0J3o7-"',—New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SIERRA ORGANICS (Circle One) <br /> Account Balance as of 12/5/2007: $626-99- 1��,$� <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/EI ment and Description Record ID Employee ID and Name Status New Owner? Delete <br /> NSF CORD-OES PR0522284 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> A443-SW COMPOST I us 8N PR0523714 EE0004680-NATALIA SUBBOTNIKOWctive Y N A I D <br /> 4633-TNC WATER SYSTEM WA0461187 EE0005838-ADRIENNE ELLSAESSEActive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,t n ersigned o r 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 th on this . I o 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 Receiv y <br /> REHS: Date / / Account out: Date lale � <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />