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Date run 9/19/2018 3:07:38PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 9/19/2018 <br />Record Selection Criteria: Facility ID FA0018534 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0015224 <br />Owner Name <br />BJ'S RESTAURANTS INC <br />Owner DBA <br />BJ'S RESTAURANTS <br />OwnerAddress <br />7755 CENTER AVE 300 <br />Phone <br />HUNTINGTON BEACH, CA 92647 <br />Home Phone <br />714-500-2400 <br />Work/Business Phone <br />714-500-2400 <br />Mailing Address <br />7755 CENTER AVE STE #300 <br />Location Code <br />HUNTINGTON BEACH, CA 92647 <br />Care of <br />002 - MILLER, KATHERINE <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0018534 10186889 <br />Facility Name <br />BJ'S RESTAURANTS <br />Location <br />5733 PACIFIC AVE <br />STOCKTON, CA 95207 <br />Phone <br />209-373-4660 x <br />Mailing Address <br />5733 Pacific Ave <br />Stockton, CA 95207 <br />Care of <br />Joseph Ramirez <br />Location Code <br />01 - STOCKTON <br />Bos District <br />002 - MILLER, KATHERINE <br />APN <br />10813022 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name KURT <br />Title MANAGER <br />Day Phone 209-373-4660 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0032801 <br />Mail Invoices to Account <br />Account Name Sarah Sawatzke <br />Account Balance as of 9/19/2018: $0.00 <br />Program/Element and Description <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Record ID Employee ID and Name <br />New Account ID: <br />Mail Invoices to: Owner / <br />Status <br />Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />New Owner? Delete <br />162E - RESTAURANT/BAR 101 + SEATS PR0527376 EE0006213 - VIDAL PEDRAZA Active Y N A I D <br />1 1 - HMBP-Regular-Primary Location PR0529900 EE0006213 - VIDAL PEDRAZA Active Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0533299 Inactive Y N A I D <br />lq1�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 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 and/or Standards and State and'or <br />Federal Laws. <br />APPLICANT'S 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 Typj Check Number Received b <br />EHD Staff: ( A WI -01— Date / / Account out: 1,i Date <br />COMMENTS: <br />Invoice #: <br />Oil W <br />