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DaleM 1n4/2016 2:44:26Pn SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Pevat <br /> R.by <br /> Facility Information as of 1/1412018 <br /> ft' r atacamcdlsft FadwM FA0011047 <br /> ---_--� Make ekengeafcorrectlona 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 /> Owner Address 200 NYALA FARMS RD <br /> WESTPORT, CT 06880-6261 <br /> Home Phone 203-222-7170 <br /> Work/Business Phone 425-881-1800 <br /> Melling 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 18465 NE 68TH ST <br /> REDMOND,WA 98052 h. <br /> Care of Terex Equipment Services <br /> Location Code 01 -STOCKTON Alt Phone <br /> Bos District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 17929034 EMall; <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Robert Morris <br /> Title <br /> Day Phone 209-242-7150 PAYME <br /> Night Phone <br /> RECEN.W <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD AR0018047 JAN 15 2M New Amount ID: <br /> Mail Invoices to AccountInvoices to: Owner I Facility I Account <br /> mENVIROMENTAL <br /> AmountNee TEREX SANJOAOUIN (cweona) <br /> TAL <br /> Account Balance as of 1/14/2016: $0.00 HEALTH DEPARTMENT <br /> (cine one) <br /> ProaraMElemenl end oa=4 aI Recall ID Em Tsanzlar to AcW <br /> playas mentl Delete.10. <br /> Name Sletus New Ownarl <br /> 1921 -HMBP-Regular-Primary Location PRO520632 EEOD09817-ROBERT LOPEZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513335 EE0000000-IIAZ MAT SJC OES Inactivr Y N A I D <br /> 2247-RCRA GEN 5<25 TONS PRO518015 EE0001421-STACY RIVERA Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO511047 EE0000000-HAZ MAT SJC DES Inectivc Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO536443 EE0002622-13ENJAMIN ESCOTTO Active Y N A 1 0 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO536330 EE0000000-HAZ MAT SJC DES InacINE Y N A 1 D <br /> 91llING aM C(MIhUU10E AGMDWLEOGENENT: I,Ye aWarelp,edwzw,eP^ral^r aspen!d aema,aWw�edpe tiwt ae aIle,arWa poem zpeofic.PNSIEIID Malya,raea eazoderoewN NialeaiM1y <br /> a eclivNymN be Gilled ro ale parry Nen4vetl a9 Ma DYMER mNi>lam I visa antilythel eil oparetiona witl Ee pai(amedin eaddarcewYh eV eppriwble Ordinarrte Codes soda SIaMeNs end Smte soda <br /> Federal Laws. �//-� <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Dele_J / <br /> Water System to be TRANSFERED: Amount Paid Dde—L—J-1:5416 <br /> Payment Type Check Number _ Received Oy <br /> EHD Stalf. Date_11_Account out• a-to <br /> COMMENTS: <br /> Inwice i:. � 73 ;?•A <br /> kece��) r1C <br />