Laserfiche WebLink
Date run 4/27/2C4 3:47:24PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by F <br />' 1 Facility Information as of 4/27/2016 Pagel <br />Record Selection Criteria: Facility ID FA0010409 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) I <br />OWNERCHANGE (date)O <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN ed Tax ID : <br />Owner ID OW0008409 O neff ID <br />Owner Name TORRES, MIGUEL ANGEL <br />Owner DBA ANGELS AUTO REPAI <br />Owner Address 4432 ABRUZZI CIR <br />STOCKTON, CA 95206 ' { <br />Home Phone 209-808-6179 <br />Work/Business Phone Not Specified <br />Mailing Address 4432 ABRUZZI CIR 17 S <br />STOCKTON, CA 95206 `l <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0010409 10183529 <br />Facility Name ANGELS AUTO REPAIR & MUFFLER <br />Location 1322 S EL DORADO ST <br />STOCKTON, CA 95206 <br />Phone 209-943-2251 <br />Mailing Address 4432 ABRUZZI CIR <br />STOCKTON, CA 95206 <br />Care of <br />Location Code 01-STOCKTON <br />BOS District 001 - VILLAPUDUA, CARLOS <br />APN 14717017 <br />EMERGENCY NOTIFICATION CONTACT INFORM TkNIMENT <br />Contact Name RECEIVE® <br />Title <br />Day Phone APR, 27 2016 <br />Night Phone <br />SAN JOAQUIN COUNTY <br />ACCOUNTS RECEIVABLE FILE INFORMATION ENVIROMENTAL <br />ALTH DEPARNT <br />TME <br />i�'T/lr:/� _Il/IL�L_� <br />. � .l���i��� <br />Alt Phone <br />Fax <br />EMail: <br />01 1,11IMAIWIM, <br />V <br />Account ID AR0017409 HE New Account ID <br />Mail Invoices to Facility Mail Invoices to: Owner <br />Account Name ANGELS AUTO REPAIR & MUFFLER <br />Account Balance as of 4/27/2 : $5,237.49 14DV'J_ - 6 <br />Program/Element and Description <br />Record ID Employee ID and Name <br />1921 - HMBP-Regular-Primary Location <br />PR0521163 <br />EE0009817 - ROBERT LOPEZ <br />2220 - SM HW GEN <5 TONS/YR <br />PR0514314 <br />EE0001421 - STACY RIVERA <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0512697 <br />EE0000000 - HAZ MAT SJC OES <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0510409 <br />EE0000000 - HAZ MAT SJC OES <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG <br />PR0533237 <br />Y <br />/ Facilit / Account <br />(Circle One) <br />Transfer to Active/Inactve <br />Status <br />N Owner? <br />Delete <br />ti <br />Active <br />N <br />I <br />D <br />Active <br />N <br />A <br />A I <br />D <br />Inactive <br />Y <br />N <br />A I <br />D <br />Inactive <br />Y <br />N <br />A I <br />D <br />Inactive <br />Y <br />N <br />A I <br />D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, ndersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated with this facility <br />or activity will be billed to the party identified as the OVA. on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State andtor <br />Federal Laws. . 1-1 <br />APPLICANT'S SIGNATURE: <br />Date IN / -17 / 4 62 <br />Program Records to be TRAN ED: $25.00 = Amount Pai Date <br />Water System to b TRA ER9D: Amount Pa •&DDate /-T7 / <br />Payment Type Check Number Received <br />EHD Staff: Date/ 2 / Account( Date <br />COMMENTS: <br />Invoice #: <br />