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Data run 9/13/2012 2:34:34Ph SAN JO WIN COUNTY ENVIRONMENTAL HEAT DEPARTMENT Report 95021 <br />Run by <br />Facility Information as of 9/13/2012 Pagel <br />Record Selection Criteria: Facility to FA0002715 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0002052 <br />Owner Name <br />NEWARK GROUP INC <br />Owner DBA <br />800 W CHURCH ST <br />Owner Address <br />20 JACKSON DR <br />Phone <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 />Standards and State andor <br />NEWARK, CA 07015 <br />Care of <br />APPLICANT'S SIGNATURE: Date <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0002715 <br />Facility Name <br />NEWARK RECYCLED FIBERS <br />Location <br />800 W CHURCH ST <br />2227 - GEN 5<25 TONS PERMIT PR0220074 EE0001421 - STACY RIVERA Active <br />STOCKTON, CA 95203 <br />Phone <br />209-464-6590 <br />Mailing Address <br />2575 GRAND CANAL BLVD STE 202 <br />ERSC - ELECTRONIC REPORTING STATE SURCRPRO534549 Active <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 9/13/2012: $0.00 <br />Pmgrzm/Elemenl and Description <br />Record I <br />Make changes/corrections in RED ink. ? <br />INFORMATION CHANGE (date) I IZ <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Site Mitigation Facility <br />Alt Phone <br />Fax <br />EI <br />Mail Invoices to: <br />New Account ID: <br />Owner / Facility / Account <br />(Circle One) <br />(Circleonitd <br />Transfer to AcliveNnactve <br />Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0519379 �^DDIUM - <br />—�! hIA2-MA*£d66�S Inactive <br />A <br />Y N I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511383 EE0000000 - HAZ MAT SJC DES Inactive <br />Y N A I D <br />2226 - CaIARP PROGRAM PRO514626 EE0000000 - HAZ MAT SJC DES Inactive <br />Y N A I D <br />2227 - GEN 5<25 TONS PERMIT PR0220074 EE0001421 - STACY RIVERA Active <br />Y N A I D <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0231063 EE0000418 - MICHAEL KITH Inactive <br />Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHAR(PR0507317 EE0000418 - MICHAEL KITH Inactive <br />Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCRPRO534549 Active <br />Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andfor project specific, PHS/EHD hourly charges associated with this facility <br />or activity will be billed to the party identifiedasthe OWNER onthis form I also certifythat <br />ttrhhat all operations will be performed in accordance with all applicable Ordinance Codes anNor <br />Standards and State andor <br />Federal Laws. <br />PL ` 00 <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: ` $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type Check Number Receiv <br />REHS:__.pM__r_��i _Date ii ll 1r1 Account out Date l <br />�1 <br />1�I� <br />COMMENTS: <br />