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Date m'n 2/9/2017 12:40:OOPM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> RReport#5021 <br /> Run by <br /> Facility Information as of 2/9/2017 Pagel <br /> Recon Selection Criteria: Facility ID FA0023415 <br /> Make changesicorrections 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 OW0021648 New Owner ID <br /> Owner Name VILLARREAL, LIONEL <br /> Owner DBA <br /> Owner Address 1501 W CHARTER WAY#B <br /> STOCKTON, CA 95206 <br /> Home Phone 415-926-3946 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1501 W CHARTER WAY#B <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> r <br /> Facility ID/CERS ID FA0023415 <br /> Facility Name Al MOBIL COMPANY <br /> Location 1501 W CHARTER WAY#B <br /> STOCKTON, CA 95206 <br /> Phone 415-926-3946 <br /> Mailing Address 1501 W CHARTER WAY#B <br /> STOCKTON, CA 95206 JA h <br /> Care of VILLARREAL, LIONEL P <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPLIDLIA, CARLOS Fax <br /> APN 16337016 EMall: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name VILLARREAL, LIONEL <br /> Title <br /> Day Phone 415-926-3946 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0043165 New Account ID: <br /> Mail Invoices to Account y� Mail Invoices to: Owner / Facility / Account <br /> Account Name At M IL COMP NY �V' (Circle One) <br /> Account Balance as of 2/9/20 $402.50 �t\t <br /> `""llll (Circle One) <br /> Transfer to ActiveAnactve <br /> PrograMElement and Description Record ID Employee ID and Name Status New OwneO Delete <br /> 1921 -HMBP-Regular-Primary Location PRO640948 EE0009817-ROBERT LOPEZ Y N A �'�1 D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO540916 EE0000026-CESAR RUVALCABA �ct' e N A//f7f D <br /> BIL LING and COMPLIANCE ACIWOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowl gethat ellsite,and/or project a(((((pacro] {£JERD ourlychargesassociatedwi t ccility <br /> or activity will be billed to the party identifietl as the OWNER on this form. I also certify that all operations will be partor ed in acwnance with all applicable Ordinance Codes and/or Standards and S e and�or <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount I laid Date <br /> Water System to be TRANSFERED: Amour Paid Date <br /> Payment Type Check Number ^�y Received by <br /> EHD Staff: VVl AP"l D-fil Date Z /=p_/ unt out: Date &L <br /> COMMENTS: <br /> Invoice#: <br /> achVIt.� <br /> ✓av /Yl <br />