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Date Run 11301202611:50:57 AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report5021 <br /> Run By TCHAMPION Facility Information as of 1/30/2026 Page t <br /> Record Selection Criteria: Facility ID FA0025198 <br /> Make changeslcorrections in RED ink, <br /> INFORMATION CHANGE{date) 113N 2(0 <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Facilitv Owner Number 4717711 SSN/Fed Tax ID; (�O�► �'� —S Ql �fj 2 <br /> Facilitv Owner Name JACKOS TACOS#6C66585 New Owner ID: <br /> Facility Owner DBA JACKOS TACOS#6C66585 V., rr h z v-k oL%rr Gt <br /> Facility Owner Address 1717 S UNION ST <br /> STOCKTON, CA 95206 <br /> Work/Business Phone <br /> Alternate Phone 2092985416 <br /> Mailing Address 1717 S UNION ST <br /> STOCKTON,CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION APN 16913327 <br /> Facility IDI CERS ID FA0025198 <br /> Facility Name JACKOS TACOS#6C66585 <br /> Facility Address 1717 S UNION ST <br /> STOCKTON, CA 95206 0 <br /> Phone 2096664133 <br /> Mailing Address 395 PIONEER AVE <br /> MANTECA, CA 95336 .rr tTAt HEt-T` <br /> Care of ICV <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Emergency Contact JACKOS TACOS#6C66585 <br /> Title FACILITY OWNER <br /> Primary Phone 2092985416 <br /> Secondary Phone 2092985416 2 d 61 — 10 b (c —_� �_ 2— <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Accounts Receivable ID 4717706 <br /> Mail Invoices to <br /> Contact Name JACKOS TACOS#6C66585 <br /> Email invoice to(up to 2 emails) JACKOSTACOS2021 @GMAIL.COM <br /> Email permit to(up to 2 emails) JACKOSTACOS2021 @GMAIL.COM <br /> Account Balance as of 1/30/2026: $0.00 <br /> Program Element and Description Record ID Employee ID and Name Status Transfer to (Circle One) <br /> New Owner? ActhrelfnactivelDelete <br /> 1635-MOBILE FOOD PREPARATION UNIT(MFPU) PRO539344 KLINHARES-KADEANNE LINHARES Active,billable Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner.operator of agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this facility or activity <br /> MR be billed to the parry identified as the OWNE.F on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State andfor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date y) / �I <br /> Program Records to be TRANSFEFRED: "$25.00= Amount Paid Date I 1 <br /> Water System to be TRANSFEFRED: Amount Paid pate / ! <br /> Payment Type Check Number Received by { ,� <br /> EHO Staff: Date 1 I Account out: _ Date' <br /> COMMENTS: <br /> INVOICE#: <br />