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Data run�►,1/31/2011 3:17:57PN SAN J 2UIN COUNTY ENVIRONMENTAL HE, H DEPARTMENT Report#5021 <br /> ^Rim by �� Pagel <br /> Facility Information as of 1/31/2011 <br /> Record 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 INDUSTRIES <br /> Owner DSA <br /> Owner Address 17 BLANCHARD <br /> NEWARK, NJ 07105 <br /> Home Phone 973-589-6853 <br /> Work/Business Phone 908-276-4000 <br /> Mailing Address 20 JACKSON ST <br /> CRANFORD, NJ 07016 <br /> Care of <br /> FACILITY FILE INFORMATION <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 f • <br /> Night Phone 209-466-7088 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021184 /00*100New Account ID: <br /> Mail Invoices to Account b C� ✓ Mail Invoices to: Owner / Facility / Account <br /> Account Nam (Circle one) <br /> Account Balance as of 1/31/2011: $0.00 <br /> (Circle One) <br /> r Transfer to Active/Inactve <br /> Program/Element and Description / Record ID Employee ID and Name / Status New Owner? Delete <br /> 2950-ENVIRON ASSESS if PR0516614 EE0000684-MICHAEL INFURNA Activew Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: ],the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,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: `$25.00= Amount Paid '36l(0 '—Date <br /> Water System to be TRANS F RED: t Amount Paid Date <br /> Payment Type er 0 "\ ko Z Received by �� <br /> REHS: Date / ! Account out: t(rc— Date /tel N, <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt 111111111111111011 �'�d <br />