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Date run 5/30/2014 11:33:57AI SAN JOA,,.,IN COUNTY ENVIRONMENTAL HEAL'`.PEPARTMENT Report x5021 <br /> Run by Pagel <br /> Facility Information as of 5/30/2014 <br /> Record Selection Criteria: Facility ID FA0011047 <br /> Make changesicorrections in RED ink. " /1 <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 800-536-1800 <br /> Mailing Address 18465 NE 68TH ST <br /> REDMOND, WA 98052 <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 <br /> Mailing Address 18465 NE 68TH ST <br /> REDMOND, WA 98052 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA 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 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name TEREX UTILITIES INC (Circle One) <br /> Account Balance as of 5/30/2014: $52.50 <br /> (Circle One) <br /> Transferlo ActivellnacNe <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 I D <br /> 2220-SM HW GEN<5 TONS/YR PRO518015 EE0001421 -STACY RIVERA Inactive Y N D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513335 EEOOOOOOO-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO511047 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536"3 EE0002620-ALFONSO ARAMBULA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO536330 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Ne undersigned owner,operator or agent of same,acknowledge Nat all site,andror project spec,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to Ne party identified as Ne OWNER on this form. I also certify that all operations will be Performed in accordance with all applicable Ordinance Codes anclor Standards and State anular <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / I <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 Rec i _ <br /> REHS: Date /_ / / Account out: Date 5/,3 / <br /> COMMENTS: <br /> j✓��� ?f1JJi0 G iy(ieTlvei 5^Zti-11115 6.>eJ o, H m <br />