Laserfiche WebLink
Date run 12/20/2016 8:39:36A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Run by Report#5021 <br /> Facility Information as of 12/20/2016 Paget <br /> Record Selection Criteria: Facility ID FA0023415 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) I <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Numberof facilities forthis owner: 1 <br /> SSN/Fed Tax ID <br /> Owner ID OW0021648 New Owner ID <br /> Owner Name VILLARREAL, LIONEL <br /> Owner DBA <br /> OwnerAddress 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 <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 <br /> Care of VILLARREAL, LIONEL <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAP IDUA, 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 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Al MOBIL COMPANY ` (Circle Ona) <br /> Account Balance as of 12/20/2016: $341.50 <br /> (Circe One) <br /> Transfarto Actiee/Inaclve <br /> Programmlement and Description Record ID Employee 10 and Name Status New Omer' Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO540948 EE0009817-ROBERT LOPEZ Active Y N A a D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO540916 EE9999998-ONE VACANTI Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor prolect specific,PHSIEHD houdy charges associated with this facility <br /> or activity will be billed to the party ideMRred as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes ander Standards and State ander <br /> Fed...I 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 AT Check Number Received b <br /> EHD Staff: .c- !_I— Date IsL Account out: Date ;L <br /> COMMENTS: <br /> Invoice#: <br />