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e <br /> Date run 12/18/2017 3:10:40P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/18/2017 <br /> Record Selection Criteria: Facility ID FA0014457 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <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 /> OwnerAddress 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 731 E MINER AVE <br /> STOCKTON, CA 95202 <br /> Phone 209-405-3593 x <br /> Mailing Address 731 E MINER AVE <br /> STOCKTON, CA 95205 <br /> care of CRISTOPHERSANCHEZ <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 <br /> Account ID AR0024537 New Accour lD: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name CRISTOPH RSANCHEZ 2c7 (c6S (Circle One) <br /> Account Balance as of 12/18/2017: $2,4 40 G 1 vm <br /> (Circe One) <br /> Transfer to Activennactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0519315 EE0009817-ROBERT LOPEZ Active YA� D <br /> 2220-SM HW GEN<5 TONSNR PRO537097 EE0001421 -STACY RIVERA Active Y A 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,andfor project specific,PHS/EHD 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 anNor Standards and State andfor <br /> Federal Laws, <br /> APPLICANTS SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: DateIK/ /:0 Account out: Date <br /> COMMENTS: �T <br /> ^t - (� Invoice#: <br /> )/C,.—,� pilN hD <br />