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Date run 2/2212018 3:23:29PA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report #5021 <br />Run by Paget <br />Facility Information as of 2/22/2018 <br />Record Selection Criteria: Facility ID FA0023592 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0021892 <br />Owner Name <br />Joaquin Morales <br />Owner DBA <br />MORALES AUTO REPAIR <br />OwnerAddress <br />902 S STANISLAUS ST <br />Phone <br />STOCKTON, CA 95206 <br />Home Phone <br />209-271-5273 <br />Work/Business Phone <br />209-271-5273 <br />Mailing Address <br />902 S Stanislaus <br />Location Code <br />Stockton, CA 95206 <br />Care of <br />MORALES-LOPEZ, JOAQUIN <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID <br />FA0023592 10707730 <br />Facility Name <br />Morales Auto Repair <br />Location <br />830 S California St <br />Stockton, CA 95206 <br />Phone <br />209-271-5273 x <br />Mailing Address <br />902 S Stanislau5 St <br />Stockton, CA 95206 <br />Care of <br />Joaquin Morales <br />Location Code <br />01 - STOCKTON <br />BOS District <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name MORALES-LOPEZ, JOAQUIN <br />Title <br />Day Phone 209-271-5273 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changes/corrections in RED ink. _VL <br />/ <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0043559 <br />Mail Invoices to Account Mail Invoices to: <br />Account Name Joaquin Morales <br />Account Balance as of 2/22/2018: $0.00 <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Activellnadve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1920 - HMBP-Common Materials PRO541192 EE0009817 - ROBERT LOPEZ Active Y N AD <br />2220 - SM HW GEN <5 TONS/YR PR0541193 EE0000026 - CESAR RUVALCABA Active Y N A RD <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andor project specific hourly charges associated with this facility <br />or activity will be billed to Ne party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State al <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 by <br />EHD Staff. �� �Z Date 2- / Z 2— y Account out: Date <br />COMMENTS: Invoice #'. <br />