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Date Run 9/26/2025 5:13:02 PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 5021 <br /> Run By SBALLWAHN Facility Information as of 9/26/2025 Page' <br /> Record Selection Criteria: Facility I❑ FA0022844 <br /> Make changeslcorrections in RED Ink, <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Facilitv Owner Number 4019189 SSN/Fed Tax ID: <br /> Facilitv Owner Name HERNANDEZ, EDGAR MANUEL New Owner ID: <br /> Facility Owner DBA TACOS CHAPALA _— k" �(A t(rS C VIGt kiiC- <br /> Facility Owner Address <br /> Work/Business Phone <br /> Alternate Phone 2094641222 <br /> Mailing Address <br /> Care of �� Q✓ �V � rP frig- <br /> FACILITY FILE INFORMATION APN <br /> Facility ID/CERS ID FA0022844 <br /> Facility Name TACOS CHAPALA <br /> Facility Address 4895 S HWY 99, E <br /> STOCKTON, CA 95215 <br /> Phone 2094718061 <br /> Mailing Address 5509 CONSUMNES DR <br /> STOCKTON, CA 95219 <br /> Care of HERNANDEZ, EDGAR MANUEL <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Emergency Contact HERNANDEZ, EDGAR MANUEL <br /> Title FACILITY OWNER <br /> Primary Phone 2094641222 <br /> Secondary Phone 2094641222 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION Rsc �r3 <br /> Accounts Receivable ID 37192 Cjg 1 b <br /> Mail Invoices to HERNANDEZ, EDGAR MANUEL <br /> Contact Name TACOS CHAPALA ENVQ� tZIS� <br /> Email invoice to(up to 2 emails) <br /> Email permit to(up to 2 emails) <br /> Account Balance as of 9/26/2025: $506.00 <br /> Program Element and Description Record It) Employee ID and Name Status New OTransfer to (Circl¢One) <br /> 9 p wner9 Act vellnactivelDelete <br /> 1523-RESTAURANT/BAR 1-20 SEATS PR0539956 CMURO-CLAUDIA MURO Active,billable Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGFMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this facility or activity <br /> will he billed to the party identified as the OWNER on this form. I also certify that all operations will he performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: -- Date 7-C•/ 'L- <br /> Program Records to be TRANSFEFRED: '$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFEFRFD: Amount Paid Date 1 1 <br /> Payment Type Check Number —/ Received by <br /> EHD Staff: Date�_J Account out: C/ Date I"` <br /> COMMENTS: INVOICE#: <br />