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r <br /> Date run 7/10/2018 4:34:59PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/10/2018 <br /> Record Selection Criteria: Facility ID FA0011047 <br /> Make changestcorrections 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 OW0009047 Case Number: H09212 New Owner ID <br /> Owner Name TEREX UTILITIES INC <br /> Owner DBA TEREX UTILITIES INC <br /> OwnerAddress 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 ID/CERS ID FA0011047 10184063 <br /> Facility Name TEREX UTILITIES INC <br /> Location 2610 LYCOMING ST <br /> STOCKTON, CA 95206 <br /> Phone 800-536-1800 x <br /> Mailing Address 2610 Lycoming Street <br /> Stockton, CA 95206 <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 Account Mail Invoices to: Owner / Facility ! Account <br /> Account Name TEREX UTILITIES INC (Circle One) <br /> Account Balance as of 7/10/2018: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520632 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513335 EE0000000-HAZ MAT SJC OES InactivE Y N A I D <br /> PR0518015 EE0000026-CESAR RUVALCABA Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0511047 EE0000000-HAZ MAT SJC OES InactivE Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536443 EE0002622-BENJAMIN ESCOTTO InactivE Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0536330 EE0000000-HAZ MAT SJC OES 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 specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRAN 4 ERED: `$24,1100= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type C k Number Received qy _ �y <br /> EHD Staff: Date /�_/ Account out: �// Date_�// Z / a <br /> COMMENTS: <br /> Invoice#: <br />