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Date; , N23/2015 4:44:58Ph SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel k5021 <br /> Run by Paget <br /> 1. Facility Information as of 3/23/2015 <br /> Record Selectors criteria: Facility ID FA0009971 <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 OW0007971 Case Number: H06087 New Owner ID : <br /> Owner Name ARTHUR TNUNES <br /> Owner DBA NUNES HAY SERVICE INC <br /> Owner Address 14967 S UNION RD <br /> MANTECA, CA 95336 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-825-7104 <br /> Mailing Address PO BOX 94 <br /> MANTECA, CA 953361121 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009971 10183089 <br /> Facility Name NUNES HAY SVC INC <br /> Location 14967 S UNION RD <br /> MANTECA, CA 95336 <br /> Phone 209-825-7104 x0 <br /> Mailing Address PO BOX 94 <br /> MANTECA, CA 953361121 _ <br /> Care of <br /> Location Code 04- MANTECA Alt Phone <br /> Bos District 003 - BESTOLARIDES, STEVE Fax <br /> APN 20410025 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 AR0016971 New Account ID: <br /> Mail Invoices to Owner 1 n Mall I oices to: Owner / Facility / Account <br /> Account Name ARTHS 1f\�1(V 1J/ a� 1 \ (Circle one) <br /> Account Balance as of 3/23/2015:: $35$35 0 \j ' <br /> (Circle One) <br /> Transler to ACAvellnagve <br /> ZWElemenl and Descripgon Record ID Employ"ID and Name Status New Owner? Delete <br /> -HMBP-Regular-Primary Location PRO520202 EE000247 -MICHA�Pncxle Active Y N A� D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512259 EE0000000- MA Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509971 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 0 <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524247 EE0000060-JENNIFER FRASE Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531774 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific,PHSrEHO hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. 1 also certify that all operations will be performed In accordance with all applicable Ordinance Codes anMor Standards and State andfor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Ff ea �,e_Aly; s-r— 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 /> RENS: Date / / Account out: Date / <br /> COMMENTS: <br /> S�Il�ls -Ko Akuti <br /> -rikt5 Oe',p A.-f'rzp� 'Re If ,en� _� . FJ(SSD� ✓� .--_ <br /> .514,Atern <br /> pV`' �lolr�-,l <br />