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Date run 5/23/2022 1:47:33PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 5/23/2022 <br />Record Selection Criteria: Facility ID FA0002025 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />owner ID <br />OW0013042 <br />Owner Name <br />Owner DBA <br />BUDGET INN & SUITES OF STOCKTON <br />Owner Address <br />4794 EWVING+�@ <br />Work/Business Phone <br />- <br />Alternative Phone <br />Mailing Address <br />4701. EWNG+�B <br />C <br />Care of <br />K4+J s' SG.L� <br />FACILITY FILE INFORMATION APN 07118016 <br />Facility ID / CERS ID FA0002025 <br />Facility Name BUDGET INN & SUITES OF STOCKTON <br />Location 3473 W HAMMER LN <br />STOCKTON, CA 95219 <br />Phone 209-473-2000 <br />Mailing Address <br />Care of Cnl nntvi nntTsorI <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone 209-473-2000 <br />Night Phone _ <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0002033 <br />Mail Invoices to Facility <br />Account Name BUDGET INN & SUITES OF STOCKTON <br />Email invoice to (up to 2 emails) hotelstockton@gmail.com <br />Email permit to (up to 2 emails) hotelstockton@gmail.com <br />Account Balance as of 5/23/2022: $587.00 <br />Program/Element and Description <br />Make changesicorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />T4Lcl4s)61'✓4k ln✓eS *� A- <br />LL <br />9Zy 9 PierrrC'Cellege- 91ild. <br />P—,Lzsev, Ile- 64 y's4/ <br />9 z z3 <br />�9 73-7,z)00 <br />Record ID Employee ID and Name <br />�e""I <br />0 - 7 z - O sS <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle O e) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />1612 - FOOD EST <500 SQ FT W/O SEATING PR0526362 EE0001699 - JOHNNY YOAKUM Inactive Y N A I D <br />2409 - HOTEL/ MOTEL >90 PR0240259 EE0000034 - NASEEM AHMED Active Y N A I D <br />3611 -PUBLIC POOL/SPA- PRIMARY PR0360575 EE0001084 - STEPHANIE RAMIREZ Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andror 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: Date -�/ /� Account out: Date <br />COMMENTS: Invoice #: n <br />