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Date run 12/19/2017 10:06:11/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 12/19/2017 Pagel <br /> Record Selection Criteria: Facility f D FA0002889 <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 I Fed Tax ID <br /> Owner ID OW0002157 New Owner ID <br /> Owner Name TOHER, JIMMY <br /> Owner DBA DANTE'S PIZZA <br /> OwnerAddress 4 E CASTLE <br /> STOCKTON, CA 95204 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-482-5290 <br /> Mailing Address 9305 THORNTON RD#H <br /> STOCKTON, CA 95209 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0002889 10181011 <br /> Facility Name DANTES PIZZA <br /> Location 9305 THORNTON RD# H <br /> STOCKTON, CA 95209 <br /> Phone 209-474-0221 x <br /> Mailing Address 9305 THORNTON RD#H <br /> STOCKTON, CA 95209 <br /> Care of Jimmy Toher <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District Fax <br /> Al 08018028 El l: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DANTES PIZZA <br /> Title <br /> Day Phone 209-474-0221 <br /> Night Phone 209-474-0221 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002450 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name DANTES PIZZA (Circle One) <br /> Account Balance as of 12/19/2017-. $0.00 <br /> (Circle One) <br /> Transferto Activellnacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PRO160095 EE0001084-STEPHANIE RAMIREZ Active Y N A I D <br /> 1919-HMBP-0O2 Only Food Facility PR0520744 Ell 084-STEPHANIE RAMIREZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513487 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0511199 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0534162 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andler project specific,PHSlPHD hourly charges associated with this facility <br /> or activity will be billed to the patty identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes ancVor Standards and State anti <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 1 Account out: Date 1 1 <br /> COMMENTS: <br /> Invoice#: <br />