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Date mn 6/2/2015 9:48:48AM SAN AQUIN COUNTY ENVIRONMENTAL IL TH DEPARTMENT Report#5021 <br /> Runts Pagel <br /> Facility Information as of 6/2/2015 <br /> Record Selection Criteria: Facility ID FA0002801 <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: 7 SSN/Fed Tax ID <br /> Owner ID OW0001766 New Owner ID <br /> Owner Name OCAT INC <br /> Owner DBA <br /> OwnerAddress 801 TENTH ST <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 ID/CERS ID FA0002801 10180997 <br /> Facility Name TACO BELL#22207 <br /> Location 5115 WEST LN <br /> STOCKTON, CA 95210 <br /> Phone 209478-7336 x <br /> Mailing Address 4306 Sisk Rd <br /> MODESTO, CA 95356 <br /> Care of OCAT, INC <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 -MILLER, KATHERINE Fax <br /> APN 10408002 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name TACO BELLBEEBE,ALAN <br /> Title <br /> Day Phone 209478-7336 <br /> Night Phone 209-478-7336 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002362 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TACO BELL#22207 (Circle One) <br /> Account Balance as of 6/2/2015: $323.00 <br /> (Circle One) <br /> Transfer to ActiveAnadve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PRO163077 EE0009488-JEFFREY WONG Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO520653 EE0000006-HAZA SAEED Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513369 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0611081 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO534548 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 specric,PHS'EHD hourly charges associated with this facility <br /> or activity will be billed to the party identifed as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and'or Standards and State and'or <br /> Federal Laws. <br /> APPLICANT'S 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 /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> IDVOICe#: <br />