Laserfiche WebLink
Date run 10/25/2018 8:34:05A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by DONNA Pagel <br /> Facility Information as of 10/25/2018 <br /> Record Selection Criteria: Facility ID FA0019720 <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 OW0016177 New Owner ID <br /> Owner Name GLENN MILLER <br /> Owner DBA LAM SPICE CO INC <br /> OwnerAddress 824 S CENTER ST <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-586-4156 <br /> Mailing Address PO BOX 640 <br /> MI WUK VILLAGE, CA 95346 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019720 10187361 <br /> Facility Name LAM SPICE CO INC <br /> Location 824 S CENTER ST <br /> STOCKTON, CA 95206 <br /> Phone 209-586-4156 x <br /> Mailing Address PO BOX 640 <br /> MI WUK VILLAGE, CA 95346 <br /> Care of GLENN MILLER <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, MIGUEL Fax <br /> APN 14714007 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035082 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name LAM SPI lot (Circle One) <br /> Account Balance as of 10/25/20 : $392.00 7i <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO529883 EE0009817-ROBERT LOPEZ Active Y N A 0 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0534184 Inactive 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,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 Rec d <br /> EHD Staff: o kms+ LoOGZ Date k /2-(0 Account out: Date /D/�/ <br /> COMMENTS: I L <br /> Y lel ��er Cp"lled s0.1� I�d�eir -��� �c-ti�m 1ne k.'D6IjaYIT CacC' Invoice#: <br /> Med o n�wwre �t:�-4- here we are wi-E'h o` b,l� �v� 20►9 -�ecs1 \ease o..dv►se. <br />