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Run by KARYF S Joaquin County PHS/EHD FACILITY INFORMATION as of 10/28/96 -- - - --- ------------------------------------------------------------------------ Make changes/corrections in RED pen or pencil: OWNER FILE INFORMATION INFORMATION CHANGE (date) ; OWNERSHIP CHANGE (date): OWNER ID: 002052 New Owner ID: 00 Owner Name: NEWARK SIERRA PAPERBOARD CORP Owner DBA: NEWARK SIERRA PAPERBOARD CORP Owner Address: 800 W CHURCH STOCKTON, CA 95203 Home Phone: Soc Sec# / Tax ID#: Ownership Type: 01 CORPORATION Mailing Address: 800 W CHURCH Care of: NEWARK SIERRA PAPERBOARD CORP STOCKTON, CA 95203 FACILITY FILE INFORMATION FACILITY ID: 002715 Facility Name: NEWARK SIERRA PAPERBOARD CORP Location: 800 W CHURCH STOCKTON 95203 Phone: Mailing Address: 800 W CHURCH Care of: NEWARK SIERRA PAPERBOARD CORP STOCKTON, CA 95203 Location Code: 01 APN: r rl !C BOS District: SIC Code: ACCOUNTS RECEIVABLE FILE INFORMATION [� � ?"4 ACCOUNT ID: 0004498 New Account ID: 000 )U �`�✓ p� Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account Account Name: NEWARK SIERRA PAPERBOARD CORP (Circle one) Account Balance as of 10/28/96 : $0 . 00 (Circle one) Record UST(s) Transfer to Activate / Inactivate ;P/E Description ID Employee Status Linked new owner? Delete 20 GEN 25150 TONS PERMIT PR220074 0008 BRIGGS ACTIVE Y N A I D 2381 UST FACILITY (BEFORE 1/84) PR231063 0418 KITH ACTIVE 3 Y N A I D _______________________________________________________________________________ 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 facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date _______________________________________________________________________________ PR Records to be TRANSFERED: x $20.00 - Amount Paid Date Water System to be TRANSFERED: x $150.00 = Amount Paid Date-- Payment ate_Payment iT/ype Check # gRecvd by ________ �� RENS or COUNTER SUPV: Date1�/ (�� / �� ACCT out: Date 10 / / / UNIT/File:-/ / _