Laserfiche WebLink
Date run 8/24/2018 4:43:29PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 8/24/2018 <br />Record Selection Criteria: Facility ID FA0010979 <br />OWNER FILE INFORMATION Number of facilities for this owner : 1 <br />Owner ID <br />OW0016336 Case Number: H09097 <br />Owner Name <br />guillermo Cervantes Figueroa <br />Owner DBA <br />GM MECHANIC AUTO REPAIR <br />OwnerAddress <br />1019 S AURORA ST <br />209-570-9999 x <br />STOCKTON, CA 95206 <br />Home Phone <br />209-271-3432 <br />Work/Business Phone <br />209-570-9999 <br />Mailing Address <br />1019 S AURORA ST <br />01-STOCKTON <br />STOCKTON, CA 95206 <br />Care of <br />GONSALES, GUILLERMO <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0010979 10184003 <br />Facility Name <br />GM AUTO REPAIR <br />Location <br />1019 S AURORA ST <br />Facility / Account <br />STOCKTON, CA 95206 <br />Phone <br />209-570-9999 x <br />Mailing Address <br />1019 S AURORA ST <br />STOCKTON, CA 95206 <br />Care of <br />guillermo <br />Location Code <br />01-STOCKTON <br />Bos District <br />001 - VILLAPUDUA, CARLOS <br />APN <br />14732008 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changes/corrections in RED ink. z <br />INFORMATION CHANGE (date) —�Z, F, <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />IgXXIIIE <br />Account ID AR0017979 <br />New Account ID: <br />: <br />Mail Invoices to Account <br />Mail Invoices to: Owner / <br />Facility / Account <br />Account Name GM AUTO REPAIR <br />(Circle One) <br />Account Balance as of 8/24/2018: $0.00 <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Program/Element and Description Record ID <br />Employee ID and Name Status <br />New Owner? <br />Delete <br />1920 - HMBP-Common Materials PR0513267 <br />EE0009817 - ROBERT LOPEZ Active <br />Y N A <br />(Z D <br />2220 - SM HW GEN <5 TONS/YR PR0514479 <br />EE0000026 - CESAR RUVALCABA Active <br />Y N A <br />I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0510979 <br />EE0000000 - HAZ MAT SJC OES Inactive <br />Y N A <br />I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0531822 <br />InactivE <br />Y N A <br />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 <br />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 andlor <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: $25.00 = <br />Amount Paid Date <br />Water System to be TRANSFERED: <br />Amount Paid Date <br />Payment Type Check Number <br />Received by <br />EHD Staff: Date / Z <br />Account out: Date _�/ <br />22/ <br />COMMENTS: <br />Invoice #: <br />