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Date run 12/22/2017 10:34:04/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by DONNA Pagel <br /> Facility Information as of 12/22/2017 <br /> Record Selection Criteria: Facility ID FA0014457 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) �� a <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0011499 New Owner ID <br /> Owner Name CRISTOPHERSANCHEZ <br /> Owner DBA <br /> Owner Address 614 SALEM WAY <br /> STOCKTON, CA 95207 <br /> Home Phone 209-405-3593 <br /> Work/Business Phone 209-405-3593 <br /> Mailing Address 731 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0014457 10184687 <br /> Facility Name CristopherS Auto Repair <br /> Location 731EMINER AVE <br /> STOCKTON, CA 95202 <br /> Phone 209-405-3593 x <br /> Mailing Address -7�3 AVE <br /> STOCKTON, CA-91524145., CD <br /> Care of CRISTOPHERSANCHEZ vS�20 J <br /> Location Code Alt Phone <br /> BOIS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 13931021 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Cristopher Sanchez <br /> Title Owner <br /> Day Phone 209-405-3593 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION n' <br /> Account ID AR0024537 NewAccount ID: <br /> Mail Invoices to Owner !" J ^div \J� Mail Invoices to: Owner / Facility / Account <br /> Account Name CRISTOPHER SANCHEZ / IFS Y�� J\ (Circle One) <br /> Account Balance as of 12/22/2017: $2,025 0 <br /> (Circle One) <br /> Transfer to Activelln ici <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 1920-HMBP-Common Materials PRO519316 EE0009817-ROBERT LOPEZ Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PRO537097✓ EE0001421 -STACY RIVERA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO536849 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this roan. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes shaver Standards and State ander <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date <br /> Water System to be TRA ISFERED: Amount Paid Date / I <br /> Payment Type Check Number Received by o' <br /> EHD Staff: 'P�2_ Date / / Account out: Date <br /> COMMENTS'. <br /> Invoice#: <br /> P40 t1 Ye }KXn/ ��eQ.se CtAQ*1S- <br />