Laserfiche WebLink
Date run 2/26/2007 4:06:41 PR SAN J QUIN COUNTY ENVI$.ONMENTAL HE -H DEPARTMENT Report#5021 <br /> Rciby <br /> Facility Information as of 2/26/2007 Pagel <br /> Record Selection Criteria: Facility ID FA0002675 <br /> Make changes/corrections in RED ink or pencil <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012123 New Owner ID <br /> Owner Name TOKHY, SHOKRON AHMAD <br /> Owner DBA FIRST BITE SICILY PIZZA <br /> Owner Address 4412 JANELL LN Z312- L • (- <br /> STOCKTON, CA 95206 _ � ;;k'��_l� Gly 91Y13 <br /> Home Phone 510-378-9402 y1S �� 7.-,-La/ <br /> Work/Business Phone 209-957-2221 <br /> Mailing Address 4412 JANELL LN <br /> STOCKTON, CA 95206 F,.�r „�I i A 91-5-33 <br /> Care of SHOKRON TOKHY T,cl /"),� (5 <br /> FACILITY FILE INFORMATION 375 4 <br /> Facility ID FA0002675 <br /> Facility Name FIRST BITE SICILY PIZZA <br /> Location 8909 THORNTON RD STE 13 <br /> STOCKTON, CA 95209 <br /> Phone 209-957-2221 <br /> Mailing Address 8909 THORNTON RD#13 <br /> STOCKTON, CA 95209 n` F,;,k i e LA (N533 <br /> Care of SHOKRON AHMAD TOKHY ; �. <br /> Location Code 01 - STOCKTON APN:08031020 <br /> BOS District 003- MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004788 �AntMail Invoices to FBcillty Mail Invoices /,Facill / Account <br /> Account Name FIRST BITE SICILY PIZZA (Circle One) <br /> Account Balance as of 2/26/2007: $0.00 <br /> T (Circle One) <br /> Transfer to <br /> Active/Inectve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1623-RESTAURANT/BAR 1-20 SEATS PRO163316 EE0003361 -MARIBEL FLOHRSCHUTActive 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 this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. r� n <br /> APPLICANT'S SIGNATURE: ,rte Date 01 <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid�U,OD Date <br /> Water System to be TRA FERED: *$372.00= Amount Paid Date <br /> Payment eck ber Received by <br /> REHS: -Date 11-7 Z� Account out: Date �/ / y� <br /> COMMENT <br /> o L� RFc MFNT. <br /> F� 2 <br /> sqN J <br /> y�F TH p VpJJ/Vn, <br /> g9TMt4 <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt Ml <br />