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Date run 2/9/2017 12:40:0013M SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Run by Report A`5021 <br /> Facility Information as of 2/9/2017 Pagel <br /> Record Selection Criteria: Facility ID FA0023415 <br /> Make changes/corrections 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 OW0021648 New Owner ID <br /> Owner Name VILLARREAL, LIONEL <br /> Owner DBA <br /> Owner Address 1501 W CHARTER WAY#B <br /> STOCKTON, CA 95206 <br /> Home Phone 415-926-3946 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1501 W CHARTER WAY#B <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION r <br /> Facility lD/CERS ID FA0023415 <br /> Facility Name Al MOBIL COMPANY <br /> Location 1501 W CHARTER WAY#B <br /> STOCKTON, CA 95206 <br /> Phone 415-926-3946 <br /> Mailing Address 1501 W CHARTER WAY#B <br /> STOCKTON, CA 95206 AA I A / <br /> Care of VILLARREAL, LIONEL V J, <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOIS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16337016 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name VILLARREAL, LIONEL <br /> Title <br /> Day Phone 415-926-3946 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0043165 New Account ID: <br /> Maillnvoicesto Account Mail Invoices to: Owner / Facility / Account <br /> Account Name AlM IL COMP NY AV (Circle One) <br /> Account Balance as of 2/9/20 $402.50 )j�j <br /> (circle one) <br /> Transfer to Activenname <br /> ProgrannElement and Description Record ID Employee ID and Name Status New Omen Delete <br /> 1921 -HMBP-Regular-Primary Location PRO540948 EE0009817-ROBERT LOPEZ IceY N A D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0540916 EE0000026-CESAR RUVALCABA ! ct' e N A� D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,sconowle ge that ell site,andar Project s(((pecify; S�EHD oudy charges <br /> associeled wi cility <br /> or activity will be billed to the party identified as the OWNER o1 Nis form I also candy that all operations will be perfo etl in accordance with all applicable Ordinance Codes andor Standards and S e ands <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$25.00= Amount aid Date <br /> Water System to be TRANSFERED: Amou Paid Date / / <br /> Payment Type Check Number Received by <br /> EHD Staff: VV) /��ID-fA Date 2 / / unt out: Date off- 1 / 1-7 <br /> COMMENTS: <br /> Invoice#: <br /> vtl <br />