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Data nun 4/1912017 4:40:43PA <br /> Run q' SAN JOAQUIN COUNTY ENVHtONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Facility Information as of 4/19/2017 Paget <br /> Record Selection Criteria: Faplity ID FA0018188 <br /> Make changeslcorrections in RED ink. p �/ <br /> INFORMATION CHANGE(date) 6 / <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 OWNERSHIP CHANGE(date) <br /> New SSN/Fed Tax ID <br /> Owner ID <br /> OW0014928 New owner to <br /> Owner Name <br /> Owner DBA GG• —7 r`L'^ L 4lJ i <br /> OwnerAddress 327.N STANISLAUS ST k r a SCS <br /> STOCKTON, CA 95202 <br /> Home Phone 96 <br /> Work/Business Phone 299.4&+-447Q-_ 3 <br /> Mailing Address 327 N STANISLAUS <br /> STOCKTON, CA 95202 <br /> Care of DHATT, RAVDEEPS & GURINDER <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FAG01 B188 <br /> Facility Name e <br /> Location 321 N STANISLAUS ST <br /> STOCKTON, CA 95202 <br /> Phone,2i;g 4&4 gq7,&_ <br /> Mailing Address az--t-"TANISLAUS ST 2 2__ Al c$ n r a us S <br /> STOCKTON, CA 95202 <br /> Care of <br /> Location Code 01 <br /> -STOCKTON _ <br /> BOS District 001 -VILLAPUDUA, CARLOS <br /> APN 13931034 Starkran <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Center <br /> Title <br /> Day Phone <br /> Night Phone <br /> J <br /> ACCOUNTS RECEIVABLE FILE INFORMATION 1 32 1 North JStanislaus St.Stockton, CA # <br /> Account ID AR0031987 <br /> Mail Invoices to Facility Paint & Auto Body An Insurance jabs welcome <br /> Account Name --"-- ----- ------ <br /> Account Balance as of 4/19/2017: $0.00 Z f ! S <br /> 12— (Cirde One) <br /> P ment and Descriptio. Record ID Employee ID and Name Status New Owner/Tiranster to �venin.me <br /> Delate <br /> 1921 HMBP-Regular-Primary Location PRO529899 EE0009817-ROBERT LOPEZ Inactive Y N I D <br /> -SM HW GEN<5 TONS/YR PRO526856 EE0009488-JEFFREY WONG Inactive Y N I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532520 Inactive Y N A I D <br /> BIW NG and COMPLIANCEAG"0M.EDGEMENr: I,the undersigned owner,operator or agent of same,acknowledge thel all site,and'or project specifiq PHSEHD hourly charges associated w this facility <br /> or so ivity will be billed to the patty Identified as the OWNER on this form. I also certify that all operations will be pertormed in.ceordanc.with all applicable Ordinance Codes and, r standards and state and'or <br /> Federal taws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be RANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date Account out: Date-_//^7 2 4 1� <br /> COMMENTS: Invoice#: e�q /I J2I <br />