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Data run 8/23/2022 8:15:07AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by ! Pagel <br /> Facility Information as of 8/23/2022 <br /> Record Selection Criteria: Facility ID FA0026477 <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 SN/ ed Tax ID <br /> Owner ID OW0025126 wrier ID : <br /> Owner Name CERVANTES CARDONA, JORGE <br /> Owner DBA LUNCHADOR <br /> Owner Address 21301 EASTERN HEIGHTS RD A <br /> LINDEN, CA 95236 CA Q46LO <br /> Work/Business Phone Not Specified y <br /> Alternative Phone 209-414-9900 - 2I— <br /> .__ Mailing Address 21301 EASTERN HEIGHTS RD 1$101 ;:�I)Y-Idql __._... <br /> LINDEN, CA 95236 h/ _.._i <br /> Care of CERVANTES CARDONA, JORGE <br /> FACILITY FILE INFORMATION APN 14723003 <br /> 31 Facility ID/CERS ID FA0026477 -" <br /> Facility Name LUNCHADOR#4TL9221 G ia. <br /> Location 730 S CALFORNIA ST <br /> STOCKTON, CA 95203 <br /> Phone 209-271-1741 xCOMM <br /> Mailing Address 21301 EASTERN HEIGHTS RD ('I <br /> LINDEN, CA 95236 !I S <br /> care of CERVANTES CARDONA, JORGE relQ -RUE jos <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CERVANTES CARDONA, JORGE <br /> IS rZ&j _'�kueitS <br /> Title <br /> FA.I' Day Phone 209-271-1741 xCOMM (611 ) -4150 - <br /> Night Phone 209-414-9900 Cell <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0050373 New Account ID: / <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account / <br /> Account Name LUNCHADOR#4TL9221 (Circle One) <br /> Email Invoice to(up to 2 emails) cervantesjc93@yahoo.com >< �srae I ry alas y x01®4 ma',i ,CoM <br /> Email permit to(up to 2 emails) cervantesjc93@yahoo.com yC tt4laSe nA ga�Gwrct 1_COM <br /> Account Balance as of 8/23/2022: $0.00 <br /> (Circle One) <br /> Transfer to ActNafirl <br /> r /Element and Description Record ID Employee ID and Name Status Now Owner? Delete <br /> 1635 MOBILE FOOD PREPARATION UNIT(MFPU) PRO546650 EE0009818-LYDIA BAKER Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andior project spee'l PHSrEHD 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 ander <br /> Federal Law& <br /> �(1(� e 23 2 z <br /> CAPPLICANT'S SIGNATURE: TqOZA Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid� -• /Date <br /> Water System to be TRANS ED Amount Paid L Date <br /> Payment Typ � � Vu er I ')�(,� Received by <br /> EFiD Stafi: ` Date_/_/ Account out: _(� Date / ZZ <br /> COMMENTS: �W <br /> 'nA yK7 / Invo1 D <br /> �VM I i <br /> CQ�_ 2QDo AUG 23 2122 <br /> JOAQUI <br /> ENVIRON M COUNTY <br /> MEAL?H DE ARM NT <br />