Laserfiche WebLink
Date run 10/31/2018 3:43:29F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/31/2018 <br /> Record Selection Criteria: Facility ID FA0016699 <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 OW0013540 New Owner ID <br /> Owner Name ROY YONEMOTO <br /> Owner DBA ROY YONEMOTO t' <br /> OwnerAddress 9269 S PRIEST RD <br /> FRENCH CAMP, CA 95231mh t U1(`f`.`Q C_!'s 0l�i�'7 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 206 `a) no <br /> FRENCH CAMP, CA 95231 �Vq'�Dih (;A- 115 1 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016699 10185259 <br /> Facility Name ROY YONEMOTO <br /> Location 9269 S PRIEST RD ewl k VL <br /> FRENCH CAMP, CA 95231 CIE151 <br /> Phone 209-982-0733 x0 (%Ori q ML' <br /> Mailing Address PO BOX 206 <br /> FRENCH CAMP, CA 95231 <br /> Care of <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 001 -VILLAPUDUA, MIGUEL Fax <br /> APN 19322036 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029581 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name ROY YONEMOTO (Circle One) <br /> Account Balance as of 10/31/2018: $0.00 <br /> (Circle One) <br /> Transferto Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> • 1958-HM-Farm Operations PR0524884 EE0002670-MUNIAPPA NAIDU InactivE Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0530542 EE0001459-VICKI MCCARTNEY InactivE Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0534313 InactiVE Y N A D <br /> 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: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received b <br /> EHD Staff: G160=:. , 4t 14 Date /�7 I / 211 L) Account out: Date LDI_L/� <br /> COMMENTS: <br /> Invoice#: <br /> Ya�'t�, <br />