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Date run 8/26/2008 8:52:14AN SAN JO_ 'TIN COUNTY ENVIRONMENTAL HEA' 'DEPARTMENT Report#5021 <br /> Run by N"IlPagel <br /> Facility Information as of 8/26/20(;8 <br /> Record Selection Criteria: Facility ID FA0012708 <br /> Make changes/corrections in RED ink or pencil. <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 NEWARK SIERRA PAPERBOARD CORP <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 PO BOX 58044 <br /> SANTA CLARA, CA 950528044 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012708 <br /> Facility Name NEWARK SIERRA PAPERBOARD CORP <br /> Location 800 W CHURCH ST <br /> STOCKTON, CA 95203 <br /> Phone 209-466-7088 <br /> Mailing Address PO BOX 58044 <br /> SANTA CLARA, CA 950528044 <br /> Care of NEWARK SIERRA PAPERBOARD CORP <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS Dis ' ERREZ, STEVE Fax <br /> APN 14523004 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name NEWARK SIERRA PAPERBOARD CORP <br /> Title �d <br /> Day Phone 209-466-7088 <br /> Night Phone 209-466-7088 1 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021184 New Account ID: <br /> Mail Invoices tocount ail Invoices to: Owner / Facility Account <br /> Account NameIACTEC ENGINEERIN & CONSULTING (Circle One) <br /> Account Balance as of 8/26/2008: $0.00 00, fmkg f <br /> yl' 11V �'1"" (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS R0516614 EE000 42-MARGA LAGORIO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,ackn edge that ail 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: '$20.00= Amount Paid V'bD Date <br /> Water System to be TRANS ERED: '$372.00= Amount Paid Date / <br /> Payment Type Check Number 1.) LA-67E-5 Received by <br /> REHS: Date Account out: G Date--(X/%,(Q 09 <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt 40110W �� <br />