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Date run 4/18/2022 11:01:56AI 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 FA0026074 <br />OWNER FILE INFORMATION Number of facilities for this owner : 1 <br />Owner ID <br />OW0024725 <br />Owner Name <br />LEO MAGDALENO JR <br />Owner DBA <br />LEO MAGDALENO JR <br />OwnerAddress <br />1821 PRINCETON AVE <br />STOCKTON, CA 95204-2924 <br />Work/Business Phone <br />Not Specified <br />Alternative Phone <br />Not Specified <br />Mailing Address <br />1821 PRINCETON AVE <br />STOCKTON, CA 95204-2924 <br />Care of <br />LEO MAGDALENO JR <br />FACILITY FILE INFORMATION APN 12315403 <br />Facility ID / CERS ID FA0026074 <br />Facility Name LEO MAGDALENO JR <br />Location 1980 W ELMWOOD AVE <br />STOCKTON, CA 95204-4131 <br />Phone <br />Mailing Address 1980 W ELMWOOD AVE <br />STOCKTON, CA 95204-4131 <br />Care of LEO MAGDALENO JR <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0049388 <br />Mail Invoices to Facility <br />Account Name LEO MAGDALENO JR <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 />Program/Element and Description <br />1253 - Lead Abatement Case <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />Record ID Employee ID and Name <br />PR0546107 EE0002089 - OMRAN SOOD <br />(Circle One) <br />Transferto Active/Inactve <br />Status New Owner? Delete <br />Active Y N A (1/) 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: <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 b <br />EHD Staff: OS66o 17 as 'I Date / C E / 22 Account out: / Date 177 121— <br />COMMENTS: (/LaW Lip <br />afsf , Invoice # <br />