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Uri-Ub-ifU 1 if(WLU) U9: 46 TED' S NEAT P. 002/002 <br /> Rx Uote/Time JUN-06-i'.012(WED 9:20 2094640130 P. 002 <br /> +—Jun. 6. 201San Jon County— Na. 010D—P. 2/2 <br /> Ilam run euerzU72 lu:10:1�tAM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DrPARTMENT rtePoneaort <br /> Run by <br /> Facility Information as of 6/612012 Panel <br /> Record Salsctlnn Colada: Feculyla FACDOE770 <br /> LL <br /> Make changeslcdrrections In RED Ink <br /> INFORMATION,CHANCE(date) <br /> OWNERSHIP CHANGE(ditle) <br /> OWNER FILE INFORMATION `"��"`"•° <br /> � OW0007770 CaSe.Number: HD5381 <br /> Owner Name BLOUDOFF, PHIL&COTRELL,JOHN G L&LA4C — �� L <br /> Owner DRA TED'S MEAT Cd INC ' <br /> Owner Address PO BOX 329 <br /> STOCKTON, CA 95201 <br /> Home Phone Not Specified <br /> WcWI3Lrsfness Phone 209-466-8061 <br /> Malling Address PO BOX 329 <br /> STOCKTON, CA 95201 <br /> Cara of <br /> FACILITY PILE INFORMATION <br /> FOCII11y 10 FA000977D <br /> Facll ly Name TEDS MEAT CO INC <br /> Location 2021 E MINER AVE <br /> STOCKTON, CA 95205 <br /> ,Phone 209-466-8061 x0 <br /> Malling Address PO.13OX 329 <br /> STOCKTON, CA 95201 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> HOS olstrlcl 001-VILLAPUDLIA Fax Z0 - 4.4,6- 6ipLA- <br /> APN /5313013 Email- <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION - <br /> Contact Name <br /> Title - <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECE VA13LE FILE INFORMATION <br /> Account ID AR0016770 NewAccaunt t <br /> Melt Invoices to Owner Mall lnvolcoe to: Owner FaC11,1 I Account <br /> Account Name BLOUDOFF, PHIL&COTRI=LL,JOHN G I odor nor) <br /> Accouht$eta3nce as of 61612012: $0.00 <br /> Transfer tIGrc1a One) <br /> PrograrnlEiemanl and OmtApCon Record 10 rMiff ee ID end Name Slaws New OOwn817 Oelenfe Ne <br /> 1921-HMO P-Regular-Primary Loca4Rn PROSIO853 EE0000044-LOWELL ALLEN Ac4ive Y N A I D <br /> 2224-HAZ MAT SUSINESS PLAN AUTHORIZATIOtPRO512058 EE0000000-HAZMAT SJC 063 Inective Y N A l D <br /> 2226-CaIARP PROGRAM PRO514670 EE0000000•HAZ HAAT SJC OES Inactivu Y N A I 0 <br /> 2399-UNIFIED PROGRAM FAG STATE SURCHAR(PR0509T70 EE0000000-WIZ MAT SJC OES Inactive Y N A 1 0 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPROS33455 ACtive Y N A 1 0 <br /> BILL INS era COMPLIANCE ACxNOWLBOe NICNr I,Ole w4vivipned a.ner,operator oragent of awa,salwoMedpa Inst*0 wla,eewo+pr*6 smolflS PHMHD newly drarpse auodetedrAln this fadllty <br /> ervdh��rniUbsalrodw heps�idenllfiedeaUte ERdnthtsltrm lel canify elro"rawmawllbepaerorr inadeardennvdthsit appGcaas orduwooC acsenwarScendmdswWStel•end's <br /> Foftal Loam <br /> APPLICANTS SIGNATURE: Date (0 1 t0 l� <br /> "gram Records to be TPLANSFEREM: 'S25-00- Amount paid Oats ! 1 <br /> W41or System to be TPANSFEREO: Amount Pald_ Date / ! <br /> Payment Type ChecK Number Racaivad <br /> REHS- Data f�J Account out: � Date 7 <br /> COMMENTS. <br /> Received Time Jun, b. 2012 10 : 50AM No. 0105 <br />