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05/08/210e? 15:11 <br /> ENVIF2 NMENVfAL H ' H PAGE 02/02 <br /> Dan nn 518/2007 3:02:23Pk1 SAN JOAQUIN COUNTY ENV7RONMEi'�TAL HEALTH DEPARTMENT <br /> Pun ry T1_' <br /> owl <br /> Facility Information of 519/2007 <br /> Aaaare aN.a1m unane: �aeYny 10T~ FA0003877 <br /> Ae chrngaa7e0ereetlone Ie RED Ink or""I. <br /> INFORMATION CHANGE(WM) <br /> �� <br /> OWNERSHIP CHANGE(date) <br /> OWNER FlLE INFORKATION f <br /> Owner ID OM008220 Onner ID <br /> Ow Name HUR, SEUNG Y ED <br /> Owner DRA QAS@€fe'T-- <br /> OwwAddteaa 35790 HIBISCUS CT <br /> FREMONT, CA 94636 -& 2007 <br /> Home Phone 510-795-1622aANJUAUUI TUUUNIY <br /> womf6vonwss atone Not Specified EFFHE 8F EMERIBENCY SERVICES <br /> Milling Address 824E YOSEMITE AVE <br /> MANTECA, CA 95336 <br /> Care of - -- "- <br /> FACILITY FILE INFORMATION <br /> ForilyID FA0003677 <br /> Facility Nsms 6B '9T, - — <br /> Location 624 E YOSEMITE AVE <br /> MANTECA, CA 95336 <br /> Phone 209623.5717 --- <br /> Mailing Address 824 E YOSEMITE <br /> MANTECA, CA 95336 - — — — <br /> Core of SEUNO Y NUR APN:22118003 <br /> Location Cods 04-MANTECA SIC Coda: <br /> SOS Dili 005-ORNELLAS, LEROY <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Acca a pR0008600 New A000unt iD _ <br /> Mail Invoices to Facility Mail Invoices l0: Owner ! Facility f Account <br /> cI tl4 01101 <br /> Acmnt Nerve FSI�F <br /> Account Balance as of 5/812007: $0.00 1CM12 011„ <br /> Trarohrro AAkvA11acPre <br /> a�•r,1� �wyN Dea�Fta PeaN',D Eminoyee lC eM Name <br /> stens Nva o+me0 Dams <br /> 1615.RETAI.MKT�=SQ FT !PREPKQD 1 LTCPR0505505 t3E00Da573•JOHN J GKSQN Active <br /> Y N A I Q <br /> 2220.Sal HW GEN 40 TOMNR PRMIS762 EE0032870-MUNIA FA NAIDU Active Y N A 1 D <br /> 2:24•NAZ MKT SUSINI!$8 PLAN AW'HOR17ATIOFKM`I 2671 EEDOOD000-HAZ M T SJG OES InactivAwee Y N A I D <br /> 22&d.PACT TRANSFER RECORD•OE3 PRO522041 Y N A I tl <br /> 2761 .UST STATE SURCHARGE FEE PRO508292 EED007219-ALISO YCUVGBLOODInactive Y N A I D <br /> 2361 •UST FACILITY PRO231659 ERDOD2670-MUNIA PA NAIOV Aodve Y N A I D <br /> 2390-UNIFIED PROGRAM FAC STATE SVRCKARaR0507395 ES00012a9-ALISO YOUNGSLOOD1ea0" Y N A I D <br /> �jpMy ar.oe+vr'wm a bo,,4 w Ae oeryedrar*d asMe NN6R�tNa Mme la ,m lunl�fyFJ^alrapme a�111 wnor"Toil <br /> di i„me6b+�+g1~mvpdwmtF lQaa M000"4aawBllndrd6�oldd• <br /> 9Yw antlroFeCVY Lar.+. <br /> APPLICANT'8 SIGNATURE: r�"'”' _ Dots rj� <br /> Qrogrwn Records to be 7RANSFERED: SZD,00^_,..,-Y__ Amount Paid Date <br /> V4snsrSystemtobeTRANSFERED: ^$372.00a � Amount Pall Gate <br /> Type Cheek Nu+++Wr P.eEe, 0y <br /> RENS:nth—" Date i.G e O,[_ Accatmt ut: Date! + /d <br /> covcl¢Nra.. RC�DC�N D <br /> MAY 1- 0 2007 <br /> pn�e saFnta�r><Hn�ialansvevo ts)6ort.rot ENVIRONMENT HEALTH <br /> PERMIT/SERVICES <br /> N� � L-C <br />