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Date run 2/2/2016 8:35:12AM SAN J46 UIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/2/2016 <br /> Record Selection Criteria: Facility ID FA0009986 <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 OW0007986 Case Number: H06139 New Owner ID <br /> Owner Name VALENZUELA, JESUS T JR <br /> Owner DBA GOLDEN GATE ORN IRON WORKS <br /> Owner Address 2489 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-941-4090 <br /> Mailing Address 2489 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009986 10183101 <br /> Facility Name GOLDEN GATE ORN IRON WORKS <br /> Location 2489 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-941-4090 x0 <br /> Mailing Address 2489 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of manuela valenzuela <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOB District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 15327034 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016986 NewAccount ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name VALENZUELA, JESUS T JR (Circle One) <br /> Account Balance as of 2/2/2016: $5,971.75 <br /> (Circle One) <br /> Transfer to ActiveAnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520004 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO517455 EE0000027-CINDY VO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512274 EEOOo000O-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509986 EEOOo0000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0531517 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,PHSEHO hourly charges associated with this facility or e <br /> be billed to the party identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anNor Standards and State anNor 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 by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> IRVOICR#: <br />