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Date run 2/13/2014 1:01:39Pn <br />Run by SAN JO*N COUNTY ENVIRONMENTAL HEALIbEPARTMENT Reponxsaz, Facility Information as of 2/13/2014 Pagel <br />Record Selection Criteria: Facility ID FA0002715 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0002052 <br />Owner Name <br />NEWARK GROUP INC <br />Owner DBA <br />N <br />Owner Address <br />20 JACKSON DR <br />PR0511383 <br />NEWARK, NJ 07015 <br />Home Phone <br />973-589-6853 <br />Work/Business Phone <br />908-276-4000 <br />Mailing Address <br />20 JACKSON ST <br />EE0000000 - HAZ MAT SJC DES <br />NEWARK, CA 07015 <br />Care of <br />N <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID FA0002715 10,180,985 <br />Facility Name NEWARK RECYCLED FIBERS <br />Location 800 W CHURCH ST <br />STOCKTON,CA 95203 <br />Phone 209-464-6590 <br />Mailing Address 2575 GRAND CANAL BLVD STE 202 <br />STOCKTON, CA 95207 <br />Care of <br />Location Code 01 - STOCKTON <br />BOS District 001 - VILLAPUDUA <br />APN 14523004 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0004498 <br />Mail Invoices to Facility <br />Account Name NEWARK RECYCLED FIBERS <br />Account Balance as of 2/13/2014: $2,022.00 <br />Program/Element and Description <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID <br />Site Mitigation Facility <br />Alt Phone <br />Fax <br />EMail: <br />Record ID Employee ID and Name <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inacde <br />Status New Omen Delete <br />1921 - HMBP-Regular-Primary Location <br />PRO519379 <br />EE0009817 - ROBERT LOPEZ <br />Active <br />Y <br />N <br />A I C <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0511383 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A I C <br />2226 - CaIARP PROGRAM <br />PR0514526 <br />EE0000000 - HAZ MAT SJC DES <br />Inactive <br />Y <br />N <br />A 1 ❑ <br />2227 - GEN 5<25 TONS PERMIT <br />PR0220074 <br />EE0001421 - STACY RIVERA <br />Active <br />Y <br />N <br />A 1 D <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete <br />PR0231063 <br />EE0000418 - MICHAEL KITH <br />Inactive <br />Y <br />N <br />A 1 D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0507317 <br />EE0000418 - MICHAEL KITH <br />Inactive <br />Y <br />N <br />A 1 D <br />4740 - WASTE TIRE SITE - EXEMPT <br />PRO537613 <br />EE0009000 - HARPRIT MATTU <br />Active <br />Y <br />N <br />A 1 D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG <br />PRO534549 <br />Inactive <br />Y <br />N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, ander project specific, PHSrEHD hourly charges <br />associated with this facility <br />or activity will be billed to the pally identified as the OWNER on this form I also certify that all operations <br />will be performed in accordance with all applicable Ordinance Codes andor <br />Standards <br />and Stale andror <br />Federal Laws. <br />APPLICANTS SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />RENS: <br />COMMENTS: <br />$25.00 = <br />Date <br />Amount Paid Date <br />_ Amount Paid Date <br />Received by_ <br />Date // Account out: Date <br />