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Date run 9/4/2013 8:31:12AM SANJ IN COUNTY ENVIRONMENTAL HEAT EPARTMENT Report#5021 <br /> Run by Pagel 1I/IfmI <br /> Facility Information as of 9/4/2013 t" J <br /> Record Selection Criteria: Facility ID FA0009802 <br /> Make changes/corrections in RED ink. cr. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007802 Case Number: H05461 New Owner ID <br /> Owner Name INJECTION MOLDING CORPORATION <br /> Owner DBA INJECTION MOLDING CORP <br /> Owner Address 10824 OLSON DR STE C <br /> RANCHO CORDOVA, CA 95670-5651 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-333-7406 <br /> Mailing Address 10824 OLSON DR STE C <br /> RANCHO CORDOVA, CA 95670-5651 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0009802 10,182,921 <br /> Facility Name INJECTION MOLDING CORPORATION <br /> Location 922 INDUSTRIAL WAY STE K <br /> LODI, CA 95240 <br /> Phone 209-333-7406 x0 <br /> Mailing Address 10824 OLSON DR STE C <br /> RANCHO CORDOVA, CA 95670-5651 <br /> Care of <br /> Location Code 02 - LODI Alt Phone <br /> BOB District 004-VOGEL, KEN Fax <br /> APN 04915011 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 AR0016802 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name INJE to <br /> DING CORPORAT f _ ^�� (Circle One) <br /> Account Balance as of 9/4/2013: `U J T�'�'Q`�, I'v/ <br /> A J '-� `I(4 I ? Circle One) <br /> Transfer to Activellnactve <br /> ePr renVElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> HMBP-Common Materials PR0520190 EE0008709-JAMIE DE LA ROSA Active Y N A D <br /> 20 SM HW GEN<5 TONS/YR PR0522198 EE0001422-ARTS CACAPIT Active Y N A D <br /> -HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512090 EE0000000-HAZ MAT SJC DES Inactive Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509802 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532749 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror 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 ander Standards and State anNcr <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: Amount Paid Date_/ / <br /> Payment Type Check Number _Receiv d y <br /> REHS: Date / / ��l Accountout: <br /> COMMENTS: <br />