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Date run 9/22/2004 4:04:45PN SAN JOWN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/22/2004 <br /> Record Selection Criteria: Facility ID FA0004231 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0003146 New Owner ID <br /> Owner Name J M MANUFACTURING CO INC <br /> Owner DBA J M MFG CO INC <br /> Owner Address 1051 SPERRY RD <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 973-535-1633 <br /> Mailing Address 9 PEACH TREE HILL RD <br /> LIVINGSTON, NJ 07039 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004231 <br /> Facility Name J-M MANUFACTURING CO INC <br /> Location 1051 SPERRY RD <br /> STOCKTON, CA 95206 <br /> Phone 209-982-1500 <br /> Mailing Address 9 PEACH TREE HILL RD <br /> LIVINGSTON, NJ 07039 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:JMMAN10 <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003913 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name J M MANUFACTURING CO INC (Circle One) <br /> Account Balance as of 9/22/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> ee ID and Name Status New Owner? Delete <br /> Record ID Employee Program/Element and Description P Y <br /> 2217-APPLIANCE RECYCLER PR0521487 EE0008844-DINA ABATE Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514024 EE0008844-DINA ABATE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512044 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0519850 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509756 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4430-SOLID WASTE CIA SITE PR0504217 EE0000370-WILLIAM MARCHESE Inactive Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0460742 EE0005838-ADRIENNE ELLSAESSEActive 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 speck,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: *$20.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: *$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />