Laserfiche WebLink
Date Run SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Run By <br />Facility Information as of 4/3/2026 <br />Record Selection Criteria:Facility ID FA0000998 <br />OWNER FILE INFORMATION <br />FACILITY FILE INFORMATION APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />StatusEmployee ID and NameProgram Element and Description Record ID <br />Active, billable1608 - CLASS A COTTAGE FOOD-DIRECT SALES PR2400276 <br />Xo <br />Date J.J.APPLICANT'S SIGNATURE: <br />* $25.00 = Amount Paid Date /.IProgram Records to be TRANSFERRED: <br />Amount Paid Date Water System to be TRANSFERRED: <br />Payment Type <br />Account out:EHD Staff: Date <br />COMMENTS:INVOICE#: <br />4/3/2026 1:36:29 PM <br />CHILO <br />Received by <br />. Date <br />Report 5021 <br />Page 1 <br />Emergency Contact BRITTNEY RIVERA <br />Title FACILITY OWNER <br />Primary Phone 2094068753 <br />Secondary Phone 2094068753 <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 />/ <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 or activity <br />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 Federal Laws. <br />CMURO - CLAUDIA MURO <br />Vo eoyL <br />1 2-4-0 <br />(Circle One) <br />Active/lnactive/Delete <br />A I D <br />Work/Business Phone <br />Alternate Phone 2094068753 <br />Mailing Address 512 N HEWITT RD <br />LINDEN, CA 95236 <br />Care of BRITTNEY RIVERA <br />Facility Owner Number 4470547 <br />Facility Owner Name BRITTNEY RIVERA <br />Facility Owner DBA R5 COTTAGE <br />Facility Owner Address 512 N HEWITT RD <br />LINDEN. CA 95236 <br />Facility ID/ CERS ID FA0000998 <br />Facility Name R5 COTTAGE <br />Facility Address 512 N HEWITT RD <br />LINDEN, CA 95236 <br />Phone 2094068753 <br />Mailing Address 512 N HEWITT RD <br />LINDEN, CA 95236 <br />Care of BRITTNEY RIVERA <br />h-ict i) - <br />fYCTf4-4C /e <br />Transfer to <br />New Owner’ <br />Y N <br /> Check Number <br />Accounts Receivable ID 4470545 <br />Mail Invoices to BRITTNEY RIVERA <br />Contact Name R5 COTTAGE <br />Email invoice to (up to 2 emails) brivera627@yahoo.com <br />Email permit to (up to 2 emails) <br />Account Balance as of 4/3/2026: $387.00