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Date run 8/2/2005 2:25:47PM SAN JG 1IN COUNTY ENVIRONMENTAL HEA` !DEPARTMENT Report#5021 <br /> Run by 4066- Pagel <br /> Facility Information as of 8/2/20roo <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 <br /> Owner ID OW0002052 New Owner ID <br /> Owner Name NEWARK SIERRA PAPERBOARD CORP I��WA lZK. G^R-t9 C <br /> Owner DBA NEWARK SIERRA PAPERBOARD CORP <br /> Owner Address 800 W CHURCH <br /> STOCKTON, CA 95203 A-O-J;:�- -D 710 S <br /> Home Phone Not Specified <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 /> Dz)f <br /> Facility ID FA0012708 <br /> Facility Name NEWARK SIERRA PAPE RD 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 COR <br /> Location Code 01 -STOCKTON 0 0 APN: 4 SZ3 0 O <br /> BOS District 001 -GUTIERREZ, STEVE — �� SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021184 P`��• Str�A``� 9 SZl dt � Lk\1 NewAccount ID: <br /> Mail Invoices to —. $37 �� �0 ``p �,P4;)ail Invoices to: Owner / Facility Account <br /> Account Name NEWARK SIERRA PAPERBOARD CORP (Circle One) <br /> Account Balance as of 8/2/2005: $0.00 � �D / <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0516614 EE0000942-MARGARET LAGORIO Active Y N A I 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 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 Date <br /> Water System to be TRANSFERED: '$558.00= Amount Paid Date <br /> Payment Type Check Number Received b <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt fto,� �..'` <br />