My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2021
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
C
>
CALIFORNIA
>
730
>
1600 - Food Program
>
PR0546831
>
COMPLIANCE INFO_2021
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
10/27/2021 1:37:23 PM
Creation date
5/18/2021 2:39:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0546831
PE
1635
FACILITY_ID
FA0001293
FACILITY_NAME
TACOS Y MARISCOS SINALOA #16301M1
STREET_NUMBER
730
Direction
S
STREET_NAME
CALIFORNIA
STREET_TYPE
ST
City
STOCKTON
Zip
95203
APN
14723003
CURRENT_STATUS
01
SITE_LOCATION
730 S CALIFORNIA ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
7
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SERVICE REQUEST <br /> Type of Business or Property FACILITY ID# SERVICE REQUEST# <br /> SRoog3sg�- <br /> OWNER/ORATOR ///'''��� <br /> r/QPeso M Cyo, z �,L <br /> FACILITY NAME ! �/rCHECK If BILLING ADDRESS <br /> � <br /> SITE ADDRESS � <br /> 1 5't7releJt Number Directron (�u Street Name od!¢/ <br /> HO E or MAILING ADDRESS If ifferent from !Address) <br /> Street Number Street Name <br /> CITY STATE ZIP <br /> S oCI`` C aS o <br /> PHONE#f ExT APN# LAND USE APPLICATION# <br /> .2611) '�t15-- 6 4,(6 S' <br /> PHONE#2 Eu. BOS DISTRICT LOCATION CODE <br /> CONTRACTOR / SERVICE REQUESTOR <br /> REQUESTO Crur� 1 <br /> z76n- C ,? <br /> CHECK If BILLINGADDRESSE-1 <br /> BUSINESS NAMEPHONE# _//5_ <br /> / - SIT. <br /> r S c,S r e q o�(o S' <br /> HOMEOr AILINGADDRES FAX# <br /> G 11 S ( <br /> CITY 5• L2 <br /> C O C ATE ZIP S`Zo b <br /> BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, <br /> acknowledge that all Site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project <br /> or activity will be billed to me or my business as identified on this form. <br /> I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUIN <br /> COUNTY Ordinance Codes,Standards,STATE and FEDERAL laws. G/ <br /> APPLICANT'S SIGNAT��URE: T t�SCI, C r0 Z DATE:I27 _ ' o .- <br /> PROPERTY/BUSINESS OWNEFS, OPERATOR/MANAGER ❑ OTHER AUTHORIZED AGENT 11 <br /> I,f APPLICAMf isnot the BILLING PARTY proof of authorization t0 sign is required Title <br /> AUTHORIZATION TO RELEASE INFORMATION: When applicable, I, the owner or operator of the property located at the <br /> above site address, hereby authorize the release of any and all results, geotechnical data and/or environmental/site assessment <br /> information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available VC4aUt>Wkwf lime it is <br /> provided to me or my representative. 1�'+/— <br /> TYPE OF SERVICE REQUESTED: <br /> COMMENTS: Np <br /> o d,4' � q rp SM JON NiAE -TAL <br /> VVVV � � HEFWIRO ALTH DE AR M NT <br /> ACCEPTED BY: Lot EMPLOYEE#: J DATE: <br /> ASSIGNEDTO: EMPLOYEE#: 33U7 <br /> DATE; ,W 2/ <br /> r <br /> Date Service Completed (if already completed): SERVICE CODE: PI E: <br /> Fee Amount: Amount Paid �S�Z — Payment Date � 2--/ <br /> Payment Type Invoice# Check# Received By: <br /> EHD SED 1111 �bt� /3 I SR FORM(Golden Rod) <br /> REVISED 11/17/2003 _7 �/ <br />
The URL can be used to link to this page
Your browser does not support the video tag.