COMPLIANCE INFO_2026 - Laserfiche WebLink

Home Browse Search

□ New Facility San Joaquin County Environmental Health Department Application Form Facility Name Commisarry Azteca Site Address City State ZIP620 S Sacramento st 95240LodiCA APN Supervisor District □ Consultation [^Change of Owner □ Repairs or Remodel □ Other □ Property Owner □ Contractor □ Architect□ Billing Party □ Facility Owner □ Facility Contact □ Contractor□ Facility Contact □ Property Owner □ Architect□ Billing Party □ Facility Owner If contractor, indicate type and license numberFirst Name Last nameAlejandro Ochoa Address City ZIP3364 E Spiess rd Acampo 95220 Phone □ Contractor□ Facility Contact □ Property Owner □ Architect□ Billing Party □ Facility Owner If contractor, indicate type and license numberLast nameFirst Name City State ZIPAddress Phone EmailPhone □ Contractor □ Architect□ Facility Contact □ Property Owner□ Facility Owner□ Billing Party If contractor, indicate type and license numberLast nameFirst Name State ZIPCityAddress EmailPhonePhone 02/05/2026DATE: 0 PROPERTY / BUSINESS OWNER □ OTHER AUTHORIZED AGENT □ OPERATOR / MANAGER Title □ Check#□ Cash Rev 07/10/2024 Contact Types required If mobile food truck or pumper truck □ Application for Operating Permit Payment Received By Email commissaryaztec^2017@gmail.corr Phone (209)712-6357 Type of Service Requested Comments VIN 1GTKP32K6L3502485 m.- sfConfirmation tt License Plate Number 64126J4 If APPLICANT is not the BILLING PARTY, proof of authorization to sign is required n AUTHORIZATION TO RELEASE INFORMATION: When applicable, I, the owner or operator of the property located at the above site addreiS^iejeby auWoflZeJthe release of any and all results, geotechnical data and/or environmental/site assessment information to the SAN JOAQUIN COUNTY ENVIRONMfNX^)LHEALTI-r DEPARTMENT as soon as it is available and at the same time it is provided to me or my representative. -- s/ Existing Facility BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project or activity will be billed to me or my business as identified on this form. I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUIN COUNTY Ordinance Codes, Standards, STATE and FEDERAL laws. APPLICANT'S SIGNATURE: Alejandro Ochoa DATE: 02/05/2026___________ Am p. >y auTnoflraCthe Accepted By<" x • Da,^-5-2.G> AssienedTTYW(A^^ Fee6l7^ State CA PEI^