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Dateiun 6/8/2011 8:58:49AM SAN JO, IN COUNTY ENVIRONMENTAL HEA- DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/8/2011 <br /> Record Selection Criteria: Facility ID FA0015049 <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 OW0011161 New Owner ID <br /> Owner Name UNIFIRST CORP <br /> Owner DBA UNIFIRST CORPORATION <br /> Owner Address 68 JONSPIN RD <br /> WILMINGTON, MA 018871086 <br /> Home Phone 209-941-8364 <br /> Work/Business Phone 978-658-8888 <br /> Mailing Address 819 N HUNTER ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0015049 Site Mitigation Facility <br /> Facility Name UNIFIRST CORP <br /> Location 819 N HUNTER <br /> STOCKTON, CA 95202 <br /> Phone 209-941-8364 <br /> Mailing Address 819 N HUNTER <br /> STOCKTON, CA 95202 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name • <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION Ca 9 Y?26 t* Aol <br /> Account ID AR0025744 Nhoe— New Account ID: : <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name (Circle One) <br /> Account Balance as of 6/8/2011: $0.00 (Circle l69s/ <br /> (Circle One) <br /> Transfer to Aclive/Inactve <br /> Program/Element and Des,;en Record ID / Employee ID and Named Status , New Owner? Delete <br /> 2960-RWQCB SITE�� PR052208/7 EE0000684-MICHAEL INFURNA Active W 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: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to b NSF RED: Amount Paid Date <br /> Payment Type Check Number 0Received by' <br /> REHS: Date / / Account out: y V �y Date / / �A <br /> COMMENTS: T <br /> \\eh-env\envision\reports\5021.rpt <br />