Laserfiche WebLink
Daterun 3/3/2015 3:01:11PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as Of 3/3/2015 Pagel <br /> Record Selection Criteria: Facility ID FAC019937 <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 OW0016360 New Owner ID <br /> Owner Name REYNOSO, FRANK <br /> Owner DBA <br /> Owner Address 1101 S CENTER ST <br /> STOCKTON, CA 952061327 <br /> Home Phone 209-518-3691 <br /> Work/Business Phone 209-405-6915 <br /> Mailing Address 1101 S CENTER ST <br /> STOCKTON, CA 952061327 <br /> Care of REYNOSO, FRANK <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019937 10187441 <br /> Facility Name IMPERIAL AUTO SPA <br /> Location 1211 S TURNPIKE RD <br /> STOCKTON, CA 95206 <br /> Phone 209-405-6915 <br /> Mailing Address 1101 S CENTER ST <br /> STOCKTON, CA 952061327 <br /> Care of REYNOSO, FRANK <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOB District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 14716005 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name FRANK REYNOSO <br /> Title <br /> Day Phone 209-405-6915 <br /> Night Phone 209-518-3691 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035516 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name IMPERIAL AUTO SPA (Circle One) <br /> Account Balance as of 3/3/2015: $3,072.25 <br /> (Circle One) <br /> Transfer to ActiveHnacNe <br /> Propram/Elemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920- MBP-Common Materials PRO530781 EE0009817-ROBERT LOPEZ Active Y N A� D <br /> 2220 M HW GEN<5 TONS/YR PR0536654 EE0001421 -STACY RIVERA Active Y N A D <br /> -ELECTRONIC REPORTING STATE SURCHARG PRO532466 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of some,acknowledge that all site,ander project specific,PHSnEHO hourly charges associated with this faulity <br /> or activity will be billed to the party identified as me OWNER on this form. I also certify that all operations will be performed In accordance with all applicable Ordinance Codes andfor Standards and State andfor <br /> Federal Lama ' k 1 <br /> APPLICANTS SIGNATURE: .J Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type LlTack Number / Account out: Receivedby <br /> Date <br /> REHS: Date / 3 yr✓ <br /> COMMENTS: <br />