Laserfiche WebLink
Date run 3/18/2010 11:52:44AI SAN JOIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by 5280 Paget <br /> Facility Information as of 3/18/201 <br /> Record Selection Criteria: Facility ID FA0000511 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0000422 New Owner ID <br /> Owner Name TREHAN, PROMOD K <br /> Owner DBA AJ'S AM/PM MINI-MART <br /> Owner Address 10203 TANK HOUSE DR <br /> STOCKTON, CA 95209 <br /> Home Phone 209-954-1480 <br /> Work/Business Phone 209-334-3678 <br /> Mailing Address 10203 TANK HOUSE DR <br /> STOCKTON, CA 95209 <br /> Care of PROMOD TREHAN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000511 <br /> Facility Name AJS AM/PM MINI MARKET <br /> Location 800 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Phone 209-334-3678 <br /> Mailing Address 800 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Care of PROMOD K TREHAN <br /> Location Code 02 -LODI Alt Phone <br /> BOIS District 004-VOGEL, KEN Fax <br /> APN 05814001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name F ROMOD K TREHAN <br /> Title <br /> Day Phone 209-334-3678 <br /> Night Phone 209-954-1480 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000510 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AJS AM/PM MINI MARKET (Circle One) <br /> Account Balance as of 3/18/2010: $0.00 <br /> (Circle One) <br /> Transfer to Activellnacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1617-RETAIL MARKET>1000 SO FT W/FOOD FPRO161886 EE0006213-VIDAL PEDRAZA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> Stale and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received <br /> RENS: Date / / Account out: Date / / 2 <br /> COMME TS: 5" '(6 PkP6�5{4a,/ <br /> \\eh-env\envision\reports\5021.rpt <br />