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Date run 7/1912017 9:25:27AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 711912017 <br /> Record Selection Criteria: Facility ID FA0019398 <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 OW0005888 New Owner ID <br /> Owner Name GRASPOINTNER, DENNIS <br /> Owner DBA MCDONALD'S <br /> OwnerAddress 2280 NORDIC WAY _ <br /> TURLOCK, CA 95382 <br /> Home Phone 209-668-4249 _ <br /> Work/Business Phone 209-857-4302 <br /> Mailing Address 2250 ROCKEFELLER DR STE 7 <br /> CERES, CA 95307 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0019398 10187223 <br /> Facility Name MCDONALDS <br /> Location 1382 COLONY RD <br /> RIPON, CA 95366 <br /> Phone 209-599-9121 x <br /> Mailing Address 2250 ROCKEFELLER DR STE 7 <br /> CERES, CA 95307 <br /> Care of DENNIS GRASPOINTNER <br /> Location Code 05 _ RIPON Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 26159010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DENNIS GRASPOINTNER <br /> Title <br /> Day Phone 209-599-9121 <br /> Night Phone 209-604-3800 Cell <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034478 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name MCDONALDS (Circle One) <br /> Account Balance as of 711912017: $0.00 <br /> (Circle One) <br /> Transfer to Aotivellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PR0529037 EE0004589-KADEANNE LINHARES Active Y N A I D <br /> 1919-HMBP-0O2 Only Food Facility PR0529919 EE0004589-KADEANNE LINHARES Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0533036 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.PHSIEHD 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 andlor Standards and State andior <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 1 Account out: Date ! 1 <br /> COMMENTS. Invoice#: <br />