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Date run 1/9/2012 2:46:43PM SAN JC AN COUNTY ENVIRONMENTAL HEE I DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/9/2012 <br /> Record Selection Criteria: Facility ID FA0002529 <br /> El <br /> Make changes/corrections in RED ink.L LE <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011162 New Owner ID <br /> Owner Name PARLET, JOHN <br /> Owner DBA JOHNS INCREDIBLE PIZZA CO <br /> Owner Address 22342 AVENIDA EMPRESA STE 220 <br /> RANCHO SANTA MARGARITA, CA 92688 <br /> Home Phone 949-916-2000 <br /> Work/Business Phone 949-916-2600 <br /> Mailing Address 22342 AVENIDA EMPRESA STE 220 <br /> RANCHO SANTA MARGARITA, CA 92688 <br /> Care of JIPC MGMT INC <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002529 �'��✓�lL`� <br /> Facility Name JOHNS INCREDIBLE PIZZA CO <br /> Location 4555 N PERSHING AVE <br /> STOCKTON, CA 95207 <br /> Phone 209-952-0537 <br /> Mailing Address 22342 AVENIDA EMPRESA STE 220 <br /> RANCHO SANTA MARGARITA, CA 92688 <br /> Care of JIPC MGMT INC <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 11017001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOHN PARLET <br /> Title <br /> Day Phone 209-952-0537 <br /> Night Phone 949-916-2000 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004636 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name JOHNS INCREDIBLE PIZZA CO (Circle One) <br /> Account Balance as of 1/9/2012: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1626-RESTAURANT/BAR 101 +SEATS PRO160551 EE0003361 -MARIBEL FLOHRSCH Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0528758 Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0532859 Active 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. <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 /> Payme T p Check Numer Received by <br /> REHS: cj ate / /� Account out: Date <br /> COMMEN S: <br /> D ri <br /> \\eh-env\envision\reports\5021.rpt <br />