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Date run 2/18/2015 2:20:26P1, SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Runty z F Pagei <br /> Facility Information as of 2/18/2015 <br /> Record Selection Cr ie. Facility ID FA0011047 <br /> III���+llake changes/corrections H RED ink. <br /> ��l/ INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities forR <br /> wner : 1 SSN/Fed Tax ID : <br /> Owner ID OW0009047 Case Number: H09212 New Owner ID <br /> Owner Name TEREX UTILITIES INC <br /> Owner DBA TEREX UTILITIES INC <br /> Owner Address 200 NYALA FARMS RD <br /> WESTPORT, CT 06880-6261 <br /> Home Phone 203-222-7170 <br /> Work/Business Phone 425-881-1800 <br /> Mailing Address 200 Nyala Farms RD. <br /> Westport, CT 06880-6261 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0011047 10184063 <br /> Facility Name TEREX UTILITIES INC <br /> Location 2610 ST L <br /> STOCKIONKTON, CAA95206 <br /> Phone 800-536-1800 x <br /> Mailing Address18465NE� ST <br /> REDMOND, WA 98052 <br /> Care of Terex Equipment Services <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 17929034 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Robert Morris <br /> Title <br /> Day Phone 209-242-7150 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0018047 New Account ID: <br /> Mail Invoices to Facility � Mail Invoices to: Owner / Facility / Account <br /> Account Name TEREX UTILITIES INC (Circle One) <br /> Account Balance as of 2/18/2015: $2,232.00 <br /> (Circle One) <br /> Transfer to Active/Incise <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520532 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513335 EE0000000-HAZ MAT SJC OES Inactivc Y N A I D <br /> 2247-RCRA GEN 5<25 TONS PRO518015 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO511047 EE0000o00-HAZ MAT SJC OES Inactivc Y N A 1 D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536443 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO536330 EE0000000-HAZ MAT SJC OES Inactivc Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billetl to the party identified as the OWNER on this form. I also cartiy that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. p,, n 1�/n� <br /> APPLICANTS SIGNATURE: IhAiL A1 RTS — Ivy-(f \VGL AS kbb - Date 2/ 1-7/ 1..J <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 Receiv [-- <br /> REHS: Date / /_ Account out: Date <br /> COMMENTS: <br />