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Run by 11/5/2012 4:44:58PN SAN JOti 'JIN COUNTY ENVIRONMENTAL HEA.' I DEPARTMENT Report#5021 <br /> Facility Information as of 11/5/2012 Pagel <br /> Record Selection Criteria: Facility ID FA0020863 <br /> Make changestcorrections 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 <br /> Facility ID FA0020863 <br /> Facility Name FORMER DOPACO <br /> Location 800 W CHURCH ST <br /> 4 If <br /> STOCKTON, CA 95203 <br /> Phone <br /> Mailing Address 20 JACKSON DRIVE <br /> CRANFORD, NJ 07016 / <br /> Care of NEWARK GROUP INC / <br /> Location Code 99 - UNINCORPORATED P Alt Phone 0 <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 AR0037480 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name WEST ENVIRONMENTAL SER &TECH INC (Circle One) <br /> Account Balance as of 11/5/2012: $427.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PR0536297 EE0000684-MICHAEL INFURNA Active Y N AI 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 t is 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 and/or Standards and State andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / 1 <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 Receiv <br /> Y <br /> RENS: .S [S� Date Account out: Date <br /> COMMENTS: <br />