Laserfiche WebLink
Date run 10/31/2013 9:03:38A SAN JOIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT <br /> Run by Report#5021 <br /> Facility Information as of 10/31/20 13 Pagel <br /> Record Selection Criteria: Facility ID FA0022006 <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 OW0018117 New Owner ID <br /> Owner Name PIMENTEL, EDMOND <br /> Owner DBA <br /> Owner Address 4202 BASS RD <br /> STOCKTON, CA 95219 <br /> Home Phone 209-610-1650 <br /> Work/Business Phone Not Specified <br /> Mailing Address 4202 BASS RD <br /> STOCKTON, CA 95219 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022006 <br /> Facility Name ACAPULCO GARDENS MEXICAN RESTAUR <br /> Location 1650 S EL DORADO ST <br /> STOCKTON, CA 95206 <br /> Phone 209-470-3132 <br /> Mailing Address 3312 W CREEK DR <br /> STOCKTON, CA 95209 <br /> Care of RENTERIA, ERNESTO <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District Fax <br /> APN 16703213 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 AR0040125 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ACAPULCO GARDENS MEXICAN RESTAURANT (Circle One) <br /> Account Balance as of 10/31/2013: $-875.00 <br /> (Circle One) <br /> Program/Element and Description Transfer to Active/Inactve <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0538098 EE0001699-JOHNNY YOAKUM 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 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 by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />