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:Diii 9/13/2012 2:34:34Ph SAN JO�UIN COUNTY ENVIRONMENTAL HEA! 1 DEPARTMENT PagelRepor #5021 <br /> Run by Pagel <br /> Facility Information as of 9/13/201 <br /> Record Selection Criteria: FacilityID FA0002715 <br /> Make changes/corrections in RED ink. T <br /> INFORMATION CHANGE(date) /J ' <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002052 New Owner ID <br /> Owner Name NEWARK GROUP INC <br /> Owner DBA <br /> Owner Address 20 JACKSON DR <br /> NEWARK, NJ 07015 <br /> Home Phone 973-589-6853 <br /> Work/Business Phone 908-276-4000 <br /> Mailing Address 20 JACKSON ST <br /> NEWARK, CA 07015 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0002715 <br /> Facility Name NEWARK RECYCLED FIBERS <br /> Location 800 W CHURCH ST <br /> STOCKTON, CA 95203 <br /> Phone 209-464-6590 <br /> Mailing Address 2575 GRAND CANAL BLVD STE 202 <br /> STOCKTON, CA 95207 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 14523004 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 AR0004498 New Account to: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name NEWARK RECYCLED FIBERS (Circle One) <br /> Account Balance as of 9/13/2012: $0.00 <br /> (Circle One) <br /> I,�Q/I I Transfer to AclivislnacNe <br /> ProgranVElement and Description Record ID EmplgAa �kd I ame LjyI'r p'k " Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519379 -& nonD000-HAZ­MA*�& gf,S Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511383 EEOc0000O-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PR0514526 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PR0220074 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231063 EE000D418-MICHAEL KITH Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0507317 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0534549 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,sanowledge that all site,andior project specific,PHS/EHD hourly charges associated with this facility <br /> or activitywill be billed to the party identified n <br /> as the OWNER on this font I also certify that all operations will be pedomed in accordance with all applicable Ordinance Codes andior Standards and State anifor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / I <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 by <br /> REHS: n Q�f t f��iL�-� Date / / , Account out: Date <br /> COMMENTS: <br />