Laserfiche WebLink
Date run 8/14/2013 3:42:04PN SAN^UIN COUNTY ENVIRONMENTAL HE.'H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/14/2013 <br /> Record Selection Criteria: Facility ID FA0009802 <br /> Make changes/corrections In RED Ink. <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 lnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name INJECTION MOLDING CORPORATION (Circle One) <br /> Account Balance as of 8/14/2013: $571.00 <br /> (Circle One) <br /> Transfer to Activellr ive <br /> Progrern/Element and Description Record ID Employee ID and Name Status New 01 Delete <br /> 1920-HMBP-Common Materials PRO520190 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0522198 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512090 EE0o00000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509802 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532749 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor proled specific,PHS/EHD hourly charges associatedwith this facility <br /> ar adivitywdl be billed to the party Identified as the OWNER on this form I also certify Net all operations will be performed in accordance with all applicable Ordinance Codes andor standards and slate anaor <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: g Date / ! Ac cou tout: Date <br /> COMMENT9r7 <br /> at <br /> � ! 1�`�� <br />