Laserfiche WebLink
Date run 5/8/2017 3:20:11 PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 5/8/2017 <br />Record Selection Criteria: Facility ID FA0020183 <br />OWNER FILE INFORMATION Number of facilities for this owner : 1 <br />Owner ID <br />OW0016583 <br />Owner Name <br />Isaias lopez <br />Owner DBA <br />ISAKS AUTO DETAIL & CAR WASH <br />OwnerAddress <br />2330 THIRD <br />TRACY, CA 95376 <br />Home Phone <br />209-836-0661 <br />Work/Business Phone <br />209-914-3080 <br />Mailing Address <br />2330 3rd <br />APN <br />tracy, CA 95376 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0020183 10447747 <br />Facility Name Isak's Auto Glass & Detail Shop <br />Location <br />7870 W ELEVENTH St <br />Tracy, CA 95304 <br />Phone <br />209-836-0661 x <br />Mailing Address <br />7870 w 11 th st <br />tracy, CA 95304 <br />Care of <br />Isaias lopez <br />Location Code <br />99 - UNINCORPORATED A <br />BOS District <br />005 - ELLIOTT BOB <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0036033 <br />Mail Invoices to Account <br />Account Name isaias4 ez <br />Account Balance as of 5/8/2017: $3 0 W L��` '2-D <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />%IIl1/.%II//rii% <br />Alt .Fax <br />- <br />Mail Invoices to: <br />New Accou nt I D: : <br />Owner / Facility / Account <br />(Circle One) <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 PR0537756 EE0000009 - NICHOLAS LOEHRER Active Y N A 7CY—"N D <br />4740 - WASTE TIRE SITE - EXEMPT PR0534902 EE0002620 -ALFONSO ARAMBULA Inactive Y N A 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 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: <br />Date <br />Program Records to be TRANSFERED: ` $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date / 1 <br />Payment Type Check Number Received by <br />EHD Staff: h Date / !�_ Account out: Date 1 D l� <br />COMMENTS: <br />InV01Ce #: <br />?w -4 l- <br />