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Date run 7/,20/2022 8:36:26AK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/20/2022 <br /> Record Selection Criteria: Facility ID FA0000909 <br /> Make changes/corrections in RED ink. <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 OW0000717 New Owner ID <br /> Owner Name S & D TARR PITT LLC <br /> Owner DBA MANTECA GROCERY OUTLET <br /> OwnerAddress 900 ARLENE CT <br /> ESCALON, CA 95336 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 760-617-2690 <br /> Mailing Address 900 ARLENE CT <br /> MANTECA, CA 95336 <br /> Care of TARR, STEVEN & DEBORAH <br /> FACILITY FILE INFORMATION APN 20829002 <br /> Facility ID/CERS ID FA0000909 <br /> Facility Name MANTECA GROCERY OUTLET <br /> Location 1391 E YOSEMITE AVE <br /> MANTECA, CA 95336 <br /> Phone 209-239-4295 <br /> Mailing Address 1391 E YOSEMITE AVE <br /> MANTECA, CA 95336 <br /> Care of TARR, DEBORAH <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name TARR, DEBORAH <br /> Title <br /> Day Phone 209-239-4295 <br /> Night Phone 209-617-2690 Cell <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000906 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MANTECA GROCERY OUTLET (Circle One) <br /> Email invoice to(up to 2 emails) manteca@groceryoutlet.com <br /> Email permit to(up to 2 emails) manteca@groceryoutlet.com <br /> Account Balance as of 7/20/2022: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1618-RETAIL MKT>2000 SQ FT (PREPKGD/LTD PRE PRO161226 EE0078788-GEHANE FAHMY Active Y N A I D <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 <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: 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 y L� <br /> EHD Staff: Date / / Account out: Date / /(-/D '2- <br /> COMMENTS: Invoice#: �+ <br />