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Date run 4/18/2022 11:03:11AP SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/18/2022 <br /> Record Selection Criteria: Facility ID FA0025335 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OVV0024001 New Owner ID <br /> Owner Name KHAN, YASSIR <br /> Owner DBA <br /> OwnerAddress 338 E LOCUST ST <br /> LODI, CA 95240 <br /> Work/Business Phone Not Specified <br /> Alternative Phone Not Specified <br /> Mailing Address <br /> Care of <br /> FACILITY FILE INFORMATION APN <br /> Facility ID/CERS ID FA0025335 <br /> Facility Name LI, YANZHONG <br /> Location 316 E LOCUST ST <br /> LODI, CA 95240 <br /> Phone <br /> Mailing Address 316 E LOCUST ST <br /> LODI, CA 95240 <br /> Care of <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0047708 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name LI, YANZHONG (Circle One) <br /> Email invoice to(up to 2 emails) <br /> Email permit to(up to 2 emails) <br /> Account Balance as of 4/18/2022: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1253-Lead Abatement Case PR0544569 EE0002089-OMRAN SOOD Inactive 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 /> EHD Staff: ncew/7684 Date 2 2 Account out: Date <br /> COMMENTS:64,ps,;p t4yp C,10/H Invoice#: <br />