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Date run 12/21/2017 10:17:531 ,SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/21/2017 <br /> Record Selection Criteria: Facility ID FA0012012 <br /> Make changes/corrections in REQ ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN I Fed Tax ID <br /> Owner ID OW0009311 New Owner ID : - <br /> Owner Name VILLARA CORPORATION <br /> Owner DBA BEUTLER CORPORATION <br /> OwnerAddress 4700 LANG AVE <br /> MCCLELLAN, CA 95652 <br /> Home Phone Not Specified <br /> Work/Business Phone 916-646-2700 <br /> Mailing Address 4700 LANG AVE <br /> MCCLELLAN, CA 95652 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility IDICERS ID FA0012012 10184147 _ <br /> Facility Name VILLARA CORPORATION _ <br /> Location 332 E WETMORE ST <br /> MANTECA, CA 95337 <br /> Phone 209-824-1082 x <br /> Mailing Address 4700 LANG AVE <br /> MCCLELLAN, CA 95652 <br /> Care of Marvin Green <br /> Location Code 04 - MANTECA Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 22104060 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOHNNY COMBS <br /> Title <br /> Day Phone 209-519-0070 <br /> Night Phone 209-478-8744 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0019047 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner ! Facility / Account <br /> Account Name VILLARA CORPORATION (Circle One) <br /> Account Balance as of 12121!2017: $0.00 <br /> (Circle One) <br /> Transfer to Activeilnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1634-FOOD VEHICLEICART(PREPKGD ONLY) PR0515023 EE0008987-SCOTT SANGALANG Inactive Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO526521 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532362 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andler 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 andler Standards and Slate andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> E H D Staff: Date 1 ! Account out: Date 1 1 <br /> COMMENTS: <br /> Invoice�: <br />