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Date;un '1' 7/3/2018 1:12:20PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 7/3/2018 <br />Record Selection Criteria: Facility ID FA0024311 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0022853 <br />Owner Name <br />Lionel Villarreal <br />Owner DBA <br />A 1 MOBILE COMPANY <br />OwnerAddress <br />1805 E MARKET ST <br />STOCKTON, CA 95205 <br />Home Phone <br />415-926-3946 <br />Work/Business Phone <br />415-926-3946 <br />Mailing Address <br />1805 E Market St <br />Stockton, CA 95205 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0024311 10752274 <br />Facility Name A-1 Mobil Company <br />Location 1805 E Market St <br />Stockton, CA 95205 <br />Phone 916-533-8806 x <br />Mailing Address 1805 E Market St <br />Stockton, CA 95205 <br />Care of Lionel Villarreal <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 AR0045288 <br />Mail Invoices to Account <br />Account Name Lionel Villarr ,1, <br />Account Balance as of 7/3/2018: $9 0 ID f I MDnS <br />Make changes/corrections in RED ink. 2 `� <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID <br />M 1 <br />Alt Phone <br />Fax <br />EMail : <br />New Account ID: <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transferto Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1920 - HMBP-Common Materials PR0542325 EE0009817 - ROBERT LOPEZ Active Y N A D <br />2220 - SM HW GEN <5 TONS/YR PR0542326 EE9999996 - THREE VACANT3 Active Y N A 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 th acility <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 Slate and/or <br />Federal Laws. <br />APPLICANTS 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 Typhi' Check Number Received by d <br />EHD Staff: Date Z/ Account out: C6 Date ' / 4, ! I a <br />t <br />COMMENTS: <br />Invoice #: <br />