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Date run 12/23/2014 8:47:13A Report#5021 <br /> SAN J�IN COUNTY ENVIRONMENTAL HEA DEPARTMENT <br /> Run by <br /> Facility Information as of 12/23/2014 Pagel <br /> Record Selection Criteria: Facility ID FA0002286 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 7 SSN/Fed Tax ID <br /> Owner ID OW0001766 New Owner ID <br /> Owner Name OCAT INC <br /> Owner DBA <br /> Owner Address 801 TENTH ST 2 <br /> MODESTO, CA 95354 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-529-6802 <br /> Mailing Address 4306 Sisk Rd <br /> MODESTO, CA 95356 <br /> Care of OCAT INC <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0002288 10180897 <br /> Facility Name TACO BELL#22201 <br /> Location 4327 E WATERLOO RD <br /> STOCKTON, CA 95215 <br /> Phone 209-931-5815 x <br /> Mailing Address 4306 Sisk Rd <br /> MODESTO, CA 95356 <br /> Care of OCAT, INC <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 08710011 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name OCAI INC, BEEBE, ALLEN J <br /> Title <br /> Day Phone 209-931-5815 <br /> Night Phone 209-931-5815 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002300 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TACO BELL#22201 (Circle One) <br /> Account Balance as of 12/23/2014: $65.00 <br /> (Circle One) <br /> Transfer to Active/Inacive <br /> PrognmvElement and Description Record ID Employee ID and Name Stews New Owners Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PRO161798 EE0001084-STEPHANIE RAMIREZ Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO520654 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513370 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO511082 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 3116-STORMWATER INSPECTION-FOOD PR0523050 EE0001084-STEPHANIE RAMIREZ Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532272 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with Nis facility <br /> or activity will be billed to me party identified as the OWNER on this form, I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andvor Standards and State and/or <br /> Federal Laws <br /> APPLICANTS 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 Received by <br /> REHS: Date_/ /_ Account out: Date <br /> COMMENTS: <br />