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Date run 6/2/2008 4:44:30PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by , <br /> Facility Information as of 6/2/2008 Pagel <br /> Record Selection Criteria: Facility ID FA0015852 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0012775 New Owner ID <br /> Owner Name TYCO ELECTRONICS CORP <br /> Owner DBA TYCO PRINTED CIRCUIT GROUP <br /> Owner Address PO BOX 3608, MS 140-42 <br /> HARRISBURG, PA 17111 <br /> Home Phone 717-986-7916 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 3608, MS 140-42 <br /> HARRISBURG, PA 17111 <br /> Care of GLEN FOSTER <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015852 <br /> Facility Name SIGMA/TYCO GROUP(FRMLY CURRENT V� <br /> Location 1950 W FREMONT ST <br /> STOCKTON, CA 952032041 <br /> Phone <br /> Mailing Address PO BOX 3608, MS 140-42 <br /> HARRISBURG, PA 17111 <br /> Care of GLEN FOSTER <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 - GUTIERREZ, STEVE Fax <br /> APN 13336040 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GLEN FOSTER <br /> Title <br /> Day Phone 717-986-7916 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027560 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SIGMA/TYCO GROUP(FRMLY CURRENT VAC) (Circle One) <br /> Account Balance as of 6/2/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2959-DTSC- HW SITE PRO523458 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: MD <br /> 1 0 ,D <br /> Program Records to be TRANSFERED: *$20.00= Amount Pai Date 6 <br /> Water System to be TRANSFEF ZD: *$372.00= A ount Paid Date <br /> Payment Type �/ Check Number �� g Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> RECE� <br /> 15 e-- JUN V��2 <br /> �( ,I�} a SpNJo 206d <br /> V V V V ��t� I /� ENS/qp UI/V <br /> �CTyDpgRTTg4 Ty <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt ON MENT <br />