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Date win 9/21/2017 11:55:25M SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9121/2017 <br /> Record Selection Criteria: Facility ID FA0021180 <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 OW0018492 New Owner ID <br /> Owner Name KOMATSU FORKLIFT USA <br /> Owner DBA <br /> Owner Address 2792 MANDELA PKWY <br /> OAKLAND, CA 94607 <br /> Home Phone 510-238-5275 <br /> Work/Business Phone 510-238-5275 <br /> Mailing Address 2792 MANDELA PARKWAY WAY <br /> OAKLAND, CA 94607 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021180 10187779 <br /> Facility Name KOMATSU FORKLIFT USA <br /> Location 3727 METRO DR STE F <br /> STOCKTON, CA 95215 <br /> Phone 209-467-7700 x0 <br /> Mailing Address 2792 MANDELA PARKWAY WAY <br /> OAKLAND, CA 94607 <br /> Care of TIM PLEASANT <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 17925044 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name PAUL KENNEDY <br /> Title <br /> Day Phone 209-467-7700 <br /> Night Phone 510-238-5275 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0038215 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name KOMATSU FORKLIFT USA (Circle One) <br /> Account Balance as of 9/21/2017: $0.00 <br /> (Circle One) <br /> Transferto Activellnac <br /> ProgmmlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO536898 EE0008709-JAMIE LIMA Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PRO638626 EE0000031 -ELIANNA FLORIDO Active Y N A 0 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: tthe undersigned owner,operator or agent ofsame,acknowledge that all site,andor project speck,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party idenlifed es the OWNER on this form. I also certify that all operations will be Performed in accordance with all applicable Ordinance Codes andor Standards and State andor <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 <br /> EHD Staff: Date / /�_ Account out: Date <br /> COMMENTS: Invoice ff: <br /> �MSIQ� V10 10irarf in o�AbM a+ +Kis <br />