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Date run 9/12/2017 8:55:24AR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report 95021 <br /> Pagel <br /> Run by Facility Information as of 9/12/2017 <br /> Record Selection Criteria: Facility ID FA0003592 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0002693 N w Owner ID : 1L <br /> Owner Name A^A^"& ^' A ,=SINC' V <br /> Owner DBA <br /> OwnerAddress 2050 E FREMONT <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 2^n 466_ASFS - <br /> MailingAddress 2050 E FREMONT <br /> STOCKTON, CA 95205 L <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0003592 <br /> Facility Name <br /> Tek L <br /> Location 2050 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Phone &9_466 — 2s74 `E Co,S-82-p0 <br /> Majling Address 2050 E FREMONT <br /> STOCKTON, CA 95205 <br /> Care of ' _ _ <br /> Location Code 01 -STOCKTON <br /> ' <br /> Bos District 001 -VILLAPUDUA, CARLOS <br /> A 15313003 pries Tek, LLC <br /> PN �` <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION ARIES TEK <br /> UC <br /> Contact Name Dan Hibler, PE <br /> Title Engineering Director <br /> Day Phone -209 466 4866 - dhibler@ariestek.com <br /> Night Phone y2QQ-466-4356- <br /> Otnce(209)465.8200 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION Stockton, <br /> E.ton,C 95205nt Cell (209)986-8204 <br /> Account ID AR0003170 www.arie CA 95205 Fax (209)465.8203 <br /> www.ariestek.com <br /> Mail Invoices to Facility -- - - -- - (circle One) <br /> Account Name <br /> i <br /> Account Balance as of 9/12/2017: $0.00 C► �� i S (Circle One) <br /> Transfer to ActiveAnactve <br /> Program/Element and Description Record ID Employee 10 and Name <br /> Status New Owner? Delete <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete <br /> PR0232313 EEOO00008-LETITIA BRIGGS Inactive 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 speck,PHSEHD hourly charges associated with this facility <br /> or activity will be biiled to the party identified as the OWNER on this farm. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> 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 /> Payment Type check Number Received b <br /> Date /�_/� Account ot: Date <br /> EHD Staff: u <br /> COMMENTS: Invoice#: <br />