Laserfiche WebLink
Date run 9/22/2008 10:47:40AI SAN JO' 'NUIN COUNTY ENVIRONMENTAL HEA' 'I DEPARTMENT Report#5021 <br /> Run by 4906 *ft/ Pagel <br /> Facility Information as of 9/22/20 <br /> Record Selection Criteria: Facility ID FA0000525 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0000133 New Owner ID <br /> Owner Name JACK IN THE BOX INC <br /> Owner DBA JACK IN THE BOX <br /> Owner Address 9330 BALBOA AVE <br /> SAN DIEGO, CA 921231516 UP 2 2 299E <br /> Home Phone 858-571-2529 <br /> Work/Business Phone 858-571-2611 SAN Jnnnl nMcul Mry <br /> Mailing Address 9330 BALBOA AVE OFFICE OF EMERGENCY SERVICES <br /> SAN DIEGO, CA 921231516 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000525 <br /> Facility Name JACK IN THE BOX#498 <br /> Location 1105 N MAIN ST <br /> MANTECA, CA 95336 <br /> Phone 209-239-9525 <br /> Mailing Address 9330 BALBOA AVE <br /> SAN DIEGO, CA 921231516 <br /> Care of <br /> Location Code 04- MANTECA Alt Phone <br /> BOB District 003- MOW, VICTOR Fax <br /> APN 21635014 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name FOODMAKER INC <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002428 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name JACK IN THE BOX#498 (Circle One) <br /> Account Balance as of 9/22/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/mactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omen Delete <br /> 1624-RESTAURANTBAR 21-50 SEATS PR0161067 EE0001084-STEPHANIE RAMIREZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513380 EEOOOOOOO-HAZ MAT SJC DES Inacflve Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO520664 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPR0511092 EE0o00000-HAZ MAT SJC OES 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 spec,PHS/EHD hourly charges associated with this <br /> facility or adWiy will be billed to the party identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> Stale amVor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\nheshenl_nf\anne\nrnd¢inne\mrwfe\Fr191 mf <br />