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Date run 5/13/2015 9:08:33AN SAN UIN COUNTY ENVIRONMENTAL HE JOH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/13/2015 <br /> Record Selection Criteria: Facility ID FA0002042 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN I Fed Tax ID <br /> Owner ID OW0001598 New Owner ID <br /> Owner Name STOCKTON SPAGHETTI RESTAURANT <br /> Owner DBA THE OLD SPAGHETTI FACTORY <br /> OwnerAddress 0715 S W BANCROFT ST <br /> PORTLAND, OR 97239 <br /> Home Phone 016-481-9474 <br /> Work/Business Phone 209-473-3695 <br /> Mailing Address 0715 S W BANCROFT ST <br /> PORTLAND, OR 97239 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FAD002042 10180857 <br /> Facility Name OLD SPAGHETTI FACTORY, THE <br /> Location 2702 W MARCH LN <br /> Stockton, CA 95219 <br /> Phone 209-473-3695 x <br /> Mailing Address 0715 S W BANCROFT ST <br /> PORTLAND, OR 97239 <br /> Care of STOCKTON SPAGHETTI RESTAURANT <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 11802007 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name THE OLD SPAGHETTI FACTORY <br /> Title <br /> Day Phone 209-473-3695 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002050 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner f Facility 1 Account <br /> Account Name OLD SPAGHETTI FACTORY, THE (Circle One) <br /> Account Balance as of 511312015: '$0.00 <br /> (Circle One) <br /> Transferto Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New owner? Delete <br /> 1626-RESTAURANT/BAR 101 +SEATS PR0160501 EE0003361 -MARIBEL FLOHRSCHUTZ Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO530861 EE0000006-HAZA SAEED Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO531768 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENTS I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,Pi 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 andlor Standards and State arl <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / ! <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date I 1 <br /> Water System to be TRANSFERED: Amount Paid Date I / <br /> Payment Type Check Number Received by <br /> REHS: Date I I Account out: Date 1 ! <br /> COMMENTS: <br />