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Date run 2/22/2018 3:23:29PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/22/2018 <br /> Record Selection Criteria: Facility ID FA0023592 <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 OW0021892 New Owner ID <br /> Owner Name Joaquin Morales <br /> Owner DBA MORALES AUTO REPAIR <br /> OwnerAddress 902 S STANISLAUS ST <br /> STOCKTON, CA 95206 <br /> Home Phone 209-271-5273 <br /> Work/Business Phone 209-271-5273 <br /> Mailing Address 902 S Stanislaus <br /> Stockton, CA 95206 <br /> Care of MORALES-LOPEZ. JOAQUIN <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0023592 10707730 <br /> Facility Name Morales Auto Repair <br /> Location 830 S California St <br /> Stockton, CA 95206 <br /> Phone 209-271-5273 x <br /> Mailing Address 902 S Stanislaus St <br /> Stockton, CA 95206 <br /> Care of Joaquin Morales <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MORALES-LOPEZ, JOAQUIN <br /> Title <br /> Day Phone 209-271-5273 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0043559 New Account ID: <br /> Mail invoices to Account Mail Invoices to: Owner / Facility I Account <br /> Account Name Joaquin Morales (Circle One) <br /> Account Balance as of 2/22/2018: $0.00 <br /> (Circle One) <br /> Transfer to Activellnadve <br /> Program)Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0541192 EE0009817-ROBERT LOPEZ Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PR0541193 EE0000026-CESAR RUVALCABA Active Y N A PD <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSEHO 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 andbr Standards and State and" <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date I / <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date Z / L 2_/ Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />