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pate run .2/28/2017 11:32:35AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT by DONNA Run Rayon nsort Pagel 1___� Facility Information as of 2/28/2017 Record Selection Cmena: Facility ID FA0015873 OWNER FILE INFORMATION Number of facilities for this owner Owner ID OW0012794 Owner Name D0W *+g-_ Owner DBA P. btlgtEriiTE6++. v^ Owner Address 124 N E ST A I D STOCKTON, CA 95205 Home Phone Not Specified Work/Business Phone 209-22T78J4 Mailing Address BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent or same, acknowledge that all site, andor project specific, PHWEHD hourly charges associated with this facility oradwity will be billed to the party Identified as the OWNER on this form. I also cenify that all operations will be performed in accordance with all applicable STOCKTON, CA 95205-0847 Care of FACILITY FILE INFORMATION Facility lD/CERS ID FA0015873 185039 Facility Name NUMERI TECH IN Location 124 N E ST STOCKTON, A 95205 Phone 209-227-7 4 X Mailing Address PO BO 847 STO ON, CA 95205-0847 Care of Dor(King Location Code // BOS District 001 - VILLAPUDUA, CARLOS APN 15318002 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name DON KING Title Day Phone 209-227-7394 XO Night Phone XO �ry✓ ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0027629 2� Mail Invoices to Account 't Account Name NUMERI TEC INC Account Balance as of 2/28/2017: $2, 2.00 Make changes/corrections in RED ink. / INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN /Fed Tax ID New Owner ID : Q d i ly :Ft e(a;4114 'A ,j/t�j n �i zLIL N. =^st-. S � c_(L'`"o�X <% �j 0 Z� 11�l TH] #7 MACHINING, INC. CNC Machining Ea Email. adilhmach.com Production & Prototypes Office: 209.949-241 1 124 N. "E" St. Cell: 916595.1680 Stockton, CA 95205 C� C.lC1,In� New Account ID: : Mail Invoices to: Owner / Facility / Account (circle One) (Circle One) APPLICANTS SIGNATURE: Program Records to be TRANSFERED: Water System to be TRANSFERED: Payment Type Check Number EHD Staff: COMMENTS Date $25.00 = Amount Paid Date // Amount Paid Date / / Received by _ Date / / Account out: Date / 1 3 /_V]__ 1 , `0., 1 YC +1,.Yv) 1Y-A,,C0.JeS I>0 � Orte_C l Y) 'Du..StY)CSS Invoice #: 7�> Ve ase o d v't s e. i Transferb Activelnach,e Program/Element and Description Record IO Employee ID and Name Status New Owner/ Delete 192 HMBP-Regular-Primary, Location PRO523494 EE0009817 - ROBERT LOPEZ Active Y N A I D 0 - SM HW GEN <5 TONS/YR PR0538497 EE0000023 - PAULINE MANGRAI Active Y N A I D ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531563 Inactiv( Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent or same, acknowledge that all site, andor project specific, PHWEHD hourly charges associated with this facility oradwity will be billed to the party Identified as the OWNER on this form. I also cenify that all operations will be performed in accordance with all applicable Ordinance Cedes andor Standards and State andor Federal Laws. APPLICANTS SIGNATURE: Program Records to be TRANSFERED: Water System to be TRANSFERED: Payment Type Check Number EHD Staff: COMMENTS Date $25.00 = Amount Paid Date // Amount Paid Date / / Received by _ Date / / Account out: Date / 1 3 /_V]__ 1 , `0., 1 YC +1,.Yv) 1Y-A,,C0.JeS I>0 � Orte_C l Y) 'Du..StY)CSS Invoice #: 7�> Ve ase o d v't s e. i