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Date run 11/5/2021 3:39:36PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 116021 <br />Run by Pagel <br />Facility Information as of 11/5/2021 <br />Record Selection Criteria: Facility ID FA0025467 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0024129 <br />Owner Name <br />MENDEZ RAMIREZ, FILBERTO <br />Owner DBA <br />DAMASOS RASPAS <br />OwnerAddress <br />1427 SNYDER ST <br />Phone <br />MANTECA, CA 95336 <br />Work/Business Phone <br />Not Specified <br />Alternative Phone <br />209-752-1106 <br />Mailing Address <br />1427 SNYDER ST <br />MANTECA, CA 95336 <br />Care of <br />MENDEZ RAMIREZ, ALBERTO <br />FACILITY FILE INFORMATION APN <br />Facility ID / CERS ID <br />FA0025467 <br />Facility Name <br />DAMASOS RASPAS <br />Location <br />1427 SNYDER ST <br />MANTECA, CA 95336 <br />Phone <br />209-752-1106 <br />Mailing Address <br />1427 SNYDER ST <br />MANTECA, CA 95336 <br />Care of <br />MENDEZ RAMIREZ, ALBERTO <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name MENDEZ RAMIREZ, FILBERTO <br />Title <br />Day Phone 209-752-1106 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0048074 <br />Mail Invoices to Facility <br />Account Name DAMASOS RASPAS <br />Email invoice to (up to 2 emails) mphiliberto82@gmail.com <br />Email permit to (up to 2 email-' <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />1 SSN / Fed Tax ID <br />New Owner ID : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />Account Balance as of 11/5/2021: $135.00 <br />(Circle One) <br />7J/^��`p4 Transfer to ActiveAnactve <br />Program/Element and Description Recur ID Employ and mPl9 e ` Status New Owner? D—eI ttt <br />1684 - SWAP MEET/FLEA MKT VENDOR STAND PRO544817 EE0009832 -VICTOR ACEVEDO Active Y N A D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, anrYor project speck, 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 anmor Standards and Slate anNor <br />Federal Laws. <br />APPLICANTS SIGNATURE: <br />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 <br />Staff: V Date / / Account out: Date <br />COM <br />COMMENTS: <br />Invoice #: <br />