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Date run , 34l ,1'2324 2:53:46PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/13/2024 <br /> Record Selection Criteria: Facility ID FA0026937 <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 OW0025585 New Owner ID <br /> Owner Name MADRIGAL GONZALEZ, IGNACIO <br /> Owner DBA EL CARRETON <br /> OwnerAddress 4900 N HWY 99 249 <br /> STOCKTON, CA 95212 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 209-810-4259 <br /> Mailing Address 4900 N HWY 99 SPC 249 <br /> STOCKTON, CA 95212 <br /> Care of MADRIGAL GONZALEZ, IGNACIO <br /> FACILITY FILE INFORMATION APN 16913327 <br /> Facility ID/CERS ID FA0026937 <br /> Facility Name EL CARRETON #1XA5839 / 440 <br /> Location 2440 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-561-1466 xCOMM <br /> Mailing Address 4900 N HWY 99 SPC 249 <br /> STOCKTON, CA 95212 <br /> Care of MADRIGAL GONZALEZ, IGNACIO <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MADRIGAL GONZALEZ, IGNACIO <br /> Title <br /> Day Phone 209-561-1466 xCOMM ,ja -- <br /> Night Phone 209-810-4259 Cell <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0051508 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name EL CARRETON #1XA5839 (Circle One) <br /> Email invoice to(up to 2 emails) <br /> Email permit to(up to 2 emails) <br /> Account Balance as of 3/13/2024: $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 /> 1635-MOBILE FOOD PREPARATION UNIT(MFPU) PR0547390 EE0078788-GEHANE FAHMY Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,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 Receive <br /> EHD Staff: �Y Date—'> Account out: Date 3 <br /> COMMENTS: <br /> Invoice#: <br /> X <br />