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Da1.Nn 10r31/201712:51:39PM SAN JOAQUIN COUNTYENVIRONDIENTAL HEALTH DEPARTIIEN'f R.WSW21 <br /> Ron T pili <br /> Facility Information as of 10/312017 <br /> RemN Seleab�c�w.n F.','D FAD003284 <br /> Make chan9aa/comct1cru In RED Ink. <br /> INFORMATION CHANGE(Clam) <br /> OWNERSHIP CHANGE(date))(�U.T1 I <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tu ID : <br /> Owner ID OWD001454 New Owner ID <br /> Owner Nemo LAL,JOGINDER Goge-1A <br /> Owner DBA 2 ,/e-rLnAntj1 T I- LA Al E <br /> Owner Address 840 DUPONT OR 054, CA `TSI <br /> STOCKTON.CA 95210 <br /> Home Phi 209-473-0534 <br /> WorldSuainess Phone 775-421-9978Mailing Address 125 E.Winnemucca Blvd. 2 1� iQAf4jT1 LA N4_ <br /> Winnemucca, NV 89445 S1Df�- C.f1 q�I N.j <br /> Care of LAL,JOGINDER <br /> FACILITY FILE INFORMATION Site Mltigadon Fa01Rty <br /> Facility ID/CERS ID FA0003284 10181081 food AYQ'T MTAs 01.4 W 4=— <br /> Facility <br /> Fa ility Name FOOD MART GASOLINE' 2 Ss T . <br /> Lora50n 2185 E FREMONT ST 5-1-JGieraN Gh <br /> STOCKTON,CA 95205 ZO 4 -51,1111— 1#-OU <br /> Phone 209-547-1700 x <br /> Mailing Address 2185 E. Fremont Street <br /> Stockton,CA 95205 <br /> Care of Joginder Lal Aft Phone 408 -S 2'G-811 <br /> Location Cone Ot -STOCKTON _ <br /> BOS District 001 -VILLAPUDUA,CARLOS Fa. 510 ado 99 6 I <br /> APN 14113045 EMH: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION `•7��,p <br /> Contact Name JA�VIE7.} 1,00fn6Y'� �rTJfi11.S�T L30N{ J11' <br /> TMe <br /> Day Phone t1L9 3 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AMDuMID AR0002858 New AcccuM lD <br /> Mall lmoioes to Account Mail Invoices to Owner / Fill / Account <br /> Account Name Joginder Lal Icna.onn <br /> Account Balance as of tO/312017: $1,705.45 <br /> Cal <br /> ine5l.lb NCM1w•M.An vgv. <br /> PmgrvmENmenleM caeuonen R.ID Empbyee lO eM Nemo SINur N.xO .O DMete <br /> 1820-HMSP-Cannan Materials PRO522271EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220.SM HWGEN<S TONS/YR PRO524255 EE9999996-THREE VACANT3 Active Y N A I D <br /> 2224.HAZ MAT BUSINESS PLAN AUTHORIZATION PRO518853 EE9999996-THREE VACANT3 Inactive Y N A I D <br /> 2227-GEN 13Q5 TONS PERMIT PROW5923 EE99999% THREE VACANT3 Inachve Y N A 1 0 <br /> 2371-UST FACILITY-1702 COMPLIANT PR0231118 EEN99996-THREE VACANT3 Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PROSf8523 EE9999998-ONE VACANTI Inachve Y N A 1 0 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FEE PRO532076 hwctive Y N A 1 D <br /> a1LLING eM LOWLMNLE eCNNOwIEDGEMENT I.Me 1mYNnIM WnernWeNrarpM gLme.WMMeJpe l.el eq We.bWM paW efaCIMt.MSn:M MuM t.veyn nsoalNMhlNSletlYry <br /> a WiWY.a b MMO bwe WM b.I11iIkE M me Ow1rER an NY tam 1 eba Dila/INI Y gwtlbMMl M pMamtl n ett=men�e wa ae.pHOde DlCnenu Cdlee andm MVMONe em gale erbb� <br /> APPLICANTS SIGNATURE. <br /> `f j'Y� ' Dare10 ;�A 1- <br /> Pmgam Records to be TRANSFERED: _'525.00=—Amount Paid <br /> Water System to be TRANSFERED: Amount Paid Date_1_I_ <br /> Payment Type Check Number ROGaved <br /> EHO Stag: Deb_/_/_ Account out Date /�/ ' <br /> COMMENTS. Invoice 0 <br />