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Date run 4913/2018 3:45:14PIV SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report #5021 <br />Run by Facility Information as of 4/13/2018 Pagel <br />Record Selection Chi Facility ID FA0024163 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0022687 <br />Owner Name <br />MCCONVEY, KATHERINE <br />Owner DBA <br />KMM TELECOMMUNICATIONS <br />Owner Address <br />4051 N HWY 121 400 <br />GRAPEVINE, TX 76051 <br />Home Phone <br />973-396-8297 <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />4051 N HWY 121 STE 400 <br />GRAPEVINE, TX 76051 <br />Care of <br />MCCONVEY, KATHERINE <br />FACILITY FILE INFORMATION & (k 7/Arhl <br />Facility ID / CERS ID <br />FA0024163 10479670 <br />Facility Name <br />KMM TELECOMMUNICATIONS <br />Location <br />4212 POCK LN <br />STOCKTON, CA 95206 <br />Phone <br />209-234-6841 <br />Mailing Address <br />4212 POCK LN <br />STOCKTON, CA 95206 <br />Care of <br />MCCONVEY KATHERINE <br />Location Code <br />01-STOCKTON <br />BOS District <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name MCCONVEY KATHERINE <br />Title <br />Day Phone 973-396-8297 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changesicorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail <br />Account ID AR0044922 <br />Mail Invoices to Facility Mail Invoices to: <br />Account Name KMM TELECOMMUNICATIONS <br />Account Balance as of 4/13/2018: $0.00 <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Tranderto ActiveJlnactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1920 - HMBP-Common Materials PR0542077 EE0008709 - JAMIE LIMA Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andor project specific, PHSIEHD hourly charges associated with this facility <br />or ac ivM1y will We Willed 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 end'or Standards and State andior <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Stag <br />COMMENTS: <br />Date /I <br />$25.00 = Amount Paid Date <br />Amount Paid Date _// <br />Received by <br />Account out: Date <br />Date <br />Invoice #: <br />