Laserfiche WebLink
Date run 6/7/2017 8:23:35AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 45021 <br /> Run by Pagel <br /> Facility Information as of 6/7/2017 <br /> Record Selection Criteria: Facility ID FA0017891 <br /> Make changeslcorrections in RED ink. --f <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN!Fed Tax ID <br /> Owner ID OW0014694 New Owner ID <br /> Owner Name TRAN, MAI & PHAM, HOANG <br /> Owner DBA PHO SAIGON TOWN <br /> Owner-Address 2364 CANTALISE DR <br /> DUBLIN, CA 94568-7835 <br /> Home Phone 646-717-2976 <br /> Work/Business Phone 209-825-8889 <br /> Mailing Address 2364 CANTALISE DR <br /> DUBLIN, CA 94568 <br /> Care of TRAN, MAI & PHAM HOANG <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0017891 <br /> Facility Name PHO SAIGON TOWN <br /> Location 1315 HISTORICAL PLAZA WAY <br /> MANTECA, CA 95336 <br /> Phone 209-825-8889 <br /> Mailing Address 1315 HISTORICAL PLAZA WAY <br /> MANTECA, CA 95336 <br /> Care of TRAN, MAI & PHAM, HOANG <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 22120052 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MAU TRAN <br /> Title OWNER <br /> Day Phone 209-825-8889 <br /> Night Phone 646_717_2976 Cell <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031372 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility 1 Account <br /> Account Name PHO SAIGON TOWN (Circle One) <br /> Account Balance as of 61712017: $329.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlEdement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PR0526438 EE0004589-KADEANNE LINHARES Active Y N AD <br /> 1919-HMBP-0O2 Only Food Facility PRO541909 EE0004589-KADEANNE LINHARES Pe rye` Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. ],the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,Pi 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 ali applicable Ordinance Codes andlor Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: Amount Paid Date ! ! <br /> Payment Type Check Number Received by <br /> EHD 5ta#. ���2 Date �Q �7 ! Account out: Date��I ^l 17 <br /> COMMENTS: <br /> _ Ir1V01Ce#: <br /> C � 2� <br />