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BILLING
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HARRISON
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1900 - Hazardous Materials Program
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PR0522712
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BILLING
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Entry Properties
Last modified
10/24/2018 3:32:20 PM
Creation date
6/9/2018 9:18:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
BILLING
RECORD_ID
PR0522712
PE
1920
FACILITY_ID
FA0015483
FACILITY_NAME
DOMENICS AUTO TECH
STREET_NUMBER
435
Direction
N
STREET_NAME
HARRISON
STREET_TYPE
ST
City
STOCKTON
Zip
95203
CURRENT_STATUS
02
SITE_LOCATION
435 N HARRISON ST
QC Status
Approved
Scanner
EJimenez
Supplemental fields
FilePath
\MIGRATIONS\H\HARRISON\435\PR0522712\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
6/8/2017 9:45:04 PM
QuestysRecordID
3422004
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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Date run 12/15/2016 5:11:52P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 12/15/2016 <br />Record Selection Criteria: Facility ID FA0015483 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0012436 <br />Owner Name <br />MERLOS, ROBERTO <br />Owner DBA <br />DOMENIC'S AUTO TECH <br />OwnerAddress <br />435 n HARRISON ST <br />Phone <br />STOCKTON, CA 95203 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />435 N HARRISON ST <br />Location Code <br />STOCKTON, CA 95203 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0015483 <br />Facility Name <br />DOMENICS AUTO TECH <br />Location <br />435 N HARRISON ST <br />STOCKTON, CA 95203 <br />Phone <br />209-943-1040 <br />Mailing Address <br />435 N HARRISON ST <br />STOCKTON, CA 95203 <br />Care of <br />Location Code <br />BOS District <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 AR0026725 <br />Mail Invoices to Owner <br />Account Name MERLOS, ROBERTO <br />Account Balance as of 12/15/2016: $0.00 <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 />Alt Phone <br />Fax <br />EMail : <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />q(Circle One) <br />` Z C- e-'" -S Transfer to Active/Inactve <br />Cram/ anrnefii d Description Record ID Employee ID and Name Status New Owner? Delete <br />- HMBP-Regular-Primary Location PR0522712 EE0009817 - ROBERT LOPEZ Inactive Y N0 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 <br />Payment Typ Check Number Received /by <br />EHD Staff: f'� - �— Date �/ !Sr / Account out: ct Date 1,;2— // 10/�(� <br />COMMENTS: ff <br />Invoice* <br />
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