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Dale mp •7/16/2018 2:54:09PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repo <br /> Run,by rl7/5021 <br /> Facility Information as of 7/16/2018 Pallet <br /> Record Sele�on CritMe: Faaky ID FA0022347 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for This owner: 1 <br /> SSN!Fed Tax ID OWNERSHIP CHANGE(date) <br /> Owner ID OW0018651 New Owner ID <br /> Owner Name KATZAKIAN,CYNDI <br /> Owner DBA <br /> Owner Address 735 N FINE RD Q <br /> LINDEN, CA <br /> Home Phone 209482-7846 <br /> Work/Business Phone 209.482_7846 <br /> Mailing Address PO BOX 1230 <br /> LINDEN, CA 95236 <br /> Care of KATZAKIAN, CYNDI r <br /> FACILITY FILE INFORMATION It <br /> I <br /> Facility ID/CERS ID FA0022347 w <br /> Facility Name BAM TREATS <br /> Location -735 N FINE RD 001 ,4a <br /> LINDEN, CA 95236 <br /> Phone 209-482-7846 <br /> Mailing Address PO BOX 1230 <br /> LINDEN, CA 95236YL <br /> Care of KATZAKIAN,CYNDI <br /> Location Code 99-UNINCORPORATED ARE Att Phone <br /> BOS,District 004-WINN, CHARLES Fax <br /> APN 10529001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name KATZAKIAN,CYNDI <br /> Title <br /> Day Phone 209-482-7846 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0040873 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility / Account <br /> Account Name BAM TREATS (clMeale) <br /> Account Balance as of 7/16/2018: $0.00 <br /> (Circle One) <br /> Pr nve,EkmeM and Description Remnd 10 E Transferta Actiwelln.cNe <br /> raPkyea lD alM Name St.m. New Owne( Dekle <br /> 1609-CLASS B COTTAGE FOOD-INDIRECT SALES PRO53BB96 EE0008999-LEYNA HUYNH Active Y N A I D <br /> 4616-TNC WATER SYSTEM-CalCODE PROW340 EE0003611-FRANK GIRARD] Temp In Y N A I D <br /> 4616-TNC WATER SYSTEM-CalCODE WA0515788 EE0003611-FRANK GIRARDI Active Y N A I D <br /> BILLING aM COMP NCE ACIelOWLEDGEMENT: 1,the u„e.,ignad vvner,opeaW,pr agent of same,a ewledge Ula(all site,aM/or project spe dap,PHS/EHD tmuny a,arges associated wio,is fadje, <br /> ar ectivitywiA DB baled ro Ne paM kentifed as dM OWNER drl etie rprrn. I ebp Mly Met ail opemt s will w pM w in acr a,va wim all appligb OMinalms Codes MWOr SfendaMs and Sble snNor <br /> Fedenallawa. <br /> l <br /> APPLICANTS SIGNATU Date <br /> Program Records to be IRAN 25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Dated / <br /> Payment Type Check Number Received b r <br /> EHD Staff: Date_// Account out: Date <br /> COMMENTS: <br /> Invoice ri: <br />