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Date run 12/29/2014 8:40:05A SAN J(WIN COUNTY ENVIRONMENTAL HEA*DEPARTMErITr Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/29/2014 <br /> Record Selection Criteria: Facility ID FA0009207 <br /> Make changes/corrections 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 OW0007207 Case Number: H02036 New Owner ID <br /> Owner Name GONZALEZ, ALEX & ERNESTO P <br /> owner DBA ARTISTIC ORNAMENTAL IRON WORKS <br /> Owner Address 2228 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Home Phone 209-465-7725 <br /> Work/Business Phone 209-465-7725 <br /> Mailing Address 2228 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009207 10182513 <br /> Facility Name ARTISTIC ORNAMENTAL IRON WORKS <br /> Location 2228 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-465-7725 x <br /> Mailing Address 2228 N WILSON WAY <br /> STOCKTON. CA 95205 <br /> Care of ALEX& ERNESTO GONZALEZ <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 11711032 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016207 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ARTISTIC ORNAMENTAL IRON WORKS (CimeOne) <br /> Account Balance as of 12/29/2014: $3,353.00 <br /> (Circle One) <br /> Transferto Active/Inactve <br /> Progran/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO519460 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0523854 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511495 EE0o00000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509207 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO632212 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific.PHSIEHO hourly charges associated with this facility <br /> or activity will be billed to the party,identified as the OWNER on this form. Ialso certify that all operations will be Performed in accordance with all applicable Ordinance Codes and'or Standards and State andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <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 Received by <br /> REHS: Date /_/ Account out: Date <br /> COMMENTS: <br />