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Date run 2/5/2013 3:58:30PM SAN JOS TIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by e 0 Pagel <br /> Facility Information as of 2/5/2013— <br /> Record <br /> /5/2013Record Selection Criteria: Facility ID FA0012708 <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 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 FA0012708 <br /> Facility Name NEWARK SIERRA PAPERBOARD/RECYCLI <br /> Location 800 W CHURCH ST <br /> STOCKTON, CA 95203 <br /> Phone 209-625-5270 <br /> Mailing Address 20 JACKSON ST <br /> CRANFORD, NJ 07016 <br /> Care of NEWARK GROUP INDUSTRIES <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 NEWARK SIERRA PAPERBOARD CORP <br /> Title <br /> Day Phone 209-466-7088 <br /> Night Phone 209-466-7088 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021184 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CASCADES INC (Circle One) <br /> Account Balance as of 2/5%2013: $-750.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PR0516614 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD hourly charges associated with this facility <br /> 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 Ordinance Codes andlor Standards and State and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />