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Date run 7/24/2017 2:51:11PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Reportue021 <br /> Run by Pagel <br /> Facility Information as of 7/24/2017 <br /> Record Selection Criteria: Facility ID FA0008023 <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: 4 SSN/Fed Tax ID <br /> Owner ID OW0006626 New Owner ID <br /> Owner Name Desmond Foods LP <br /> Owner DBA <br /> Owner Address 312 W CROMWELL AVE <br /> FRESNO, CA 93711 <br /> Home Phone 559-435-9648 <br /> Work/Business Phone 559-435-9648 <br /> Mailing Address 312 W. Cromwell Ave <br /> Fresno, CA 93711 <br /> Care of ACCOUNTING <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0008023 10182329 <br /> Facility Name Wendy's#2659 <br /> Location 3810 E HAMMER LN <br /> STOCKTON, CA 95212 <br /> Phone 559-650-7835 x <br /> Mailing Address 3810 E Hammer Ln <br /> Stockton, CA 95212 <br /> Care of Desmond Foods LP <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ZOE KANAN <br /> Title DIRECTOR AREA OPERATIONS <br /> Day Phone 209-952-0333 <br /> Night Phone 916-749-6164 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0015010 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Wendy's#2659 (Cirde One) <br /> Account Balance as of 7/24/2017: $0.00 <br /> (Cirde One) <br /> Transfer to Active/Inadve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PRO508257 EE0009488-JEFFREY WONG Active Y N A I D <br /> 1919-HMBP-0O2 Only Food Facility PRO520985 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0517647 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO517648 EE0000149-RAYMOND BORGES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533594 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHS/EHD hourly charges associated with this facility <br /> or activitywill 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 andror Standards and State and'or <br /> Federal Laws. <br /> APPLICANTS 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 Received by <br /> EHD Staff: Date / /mss Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />