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,.� Report#5021 <br /> fmle;.m ••9l'13/2012 2:34:08PR SAN JCL •UIN COUNTY ENVIRONMENTAL HEAr�I DEPARTMENT Pagel <br /> Run by y Facility Information as of 9/13/2012 <br /> Record Selection Criteria: Facility ID FA0007696 '1 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0006357 New Owner ID <br /> owner Name NEWARK GROUP INDUSTRIES <br /> owner DBA RECYCLED FIBERS <br /> Owner Address 2575 GRAND CANAL BLVD STE 202 <br /> STOCKTON, CA 952078250 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-464-6590 - <br /> Mailing Address 2575 GRAND CANAL BLVD STE 202 <br /> STOCKTON, CA 952078250 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007696 <br /> Facility Name RECYCLED FIBERS <br /> Location 800 W CHURCH ST <br /> STOCKTON, CA 95203 <br /> Phone 209464-6590 <br /> Mailing Address 2575 GRAND CANAL BLVD STE 202 <br /> STOCKTON, CA 952078250 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOIS 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 AR0013293 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name RECYCLED FIBERS (Circle One) <br /> Account Balance as of 9/13/2012: $0.00 <br /> (Circle One) <br /> Transferto Activennsche <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0524662 EE0009817-ROBERT LOPEZ Active Y N A D <br /> 2227-GEN 5<25 TONS PERMIT PR0507052 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0507053 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCRPR0533356 Active Y N A 0 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project speck,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed!to Ne parry identified as the OWNER on this form I also certdy that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Slate andor <br /> Federal Laws. <br /> p (eefy , Pe Nil I -F tn9c, , Uupllc,4� F l� <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date •tr^^ <br /> Water System to be TRANSFERED: Amount Paid Date / /_}. ) Oma Z1I5 <br /> PaymentT pe Check Number Racei I I <br /> REHS: � e ailj f/�_ Date ^l l Account out: Date <br /> COMMENTS:_ ' <br />