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Datemn 8/25/2015 11:33:41AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/25/2015 <br /> Record Selection Criteria: Facility ID FA0001126 /] <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) / <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Numbe acilitiesfor this owner: 3 SSN/Fed Tax ID 0100 0 0 53 3-7 <br /> Owner ID OW 0720 New Owner ID <br /> Owner Name INTA, FRANKJR <br /> Owner DBA <br /> Owner Address 1892 OLIVEWOOD O 5 <br /> MANTECA, CA 95336 <br /> Home Phone 209-823-7225 <br /> Work/Business Phone 209-239-9575 O s <br /> Mailing Address 305 W UNION RD <br /> MANTECA, CA 95337 C' e <br /> Care of GUINTA, FRANK a „� <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0001126 S0.M e <br /> Facility Name UNCLE FRANKS GRILL m2 <br /> Location 305 N UNION RD Sc vv P <br /> MANTECA, CA 95337 SG M P <br /> Phone 209-825-8524 <br /> Mailing Address 305 N UNION RDr n e <br /> MANTECA, CA 95337 <br /> Care of UNCLE FRANKS GRILL o ✓� n„� �t <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 003- BESTOLARIDES, STEVE Fax <br /> APN 20015002 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name FRANK GUINTA JR <br /> Title <br /> Day Phone 209-825-2501 v <br /> Night Phone 209-823-7225 lkOTIP 6�t <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0001124 w Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner Facility / Account <br /> Account Name FRANKS GR /� /,��1 of <br /> Account Balance as of 8/ 5/2015: $0.00 A& `��(� /l ��l <br /> ccive/ oriel <br /> PrograMElement and Description eco Em to ee IOD and Name Status Transfer to ACOve tete ve <br /> P Y New Owne/! Delete <br /> 1624-RESTAURANT/BAR 21-50 S PRO161078 EE0004589-KADEANNE LINHARES Active YO N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specdic,PHS/EHD hourly charges associated with This facility <br /> or activity will be billed to the party identified a/thWNER on this forth. Ialso cern that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ander <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date �'r <br /> Program Records to be TRANSFERED: _*$25.00=_ Amount Paid Date_/_/ <br /> Water System o be T �ERED: Amount Paid Date <br /> Paymen yp —�,�1 Check Number Received b <br /> EHD St ff: ” �/ Date /O / Account out: _ Date <br /> COMMENTS: Invoice#: ?-je nq Cnn <br /> a7D65 -7o FX bLCA)�-)l l a <br />