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Date mn 8/11/2011 11:49:59AI SAN JUIN COUNTY ENVIRONMENTAL HEDEPARTMENT Report #5021 <br />Run by <br />Pagel <br />Facility Information as of 8/11/2 <br />Record Selection Criteria: Facility ID FA0002715 <br />Make changes/corrections in RED ink. '3" <br />O <br />INFORMATION CHANGE <br />(date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />SSN / Fed Tax ID <br />Owner ID OW0002052 <br />New ID : <br />Owner Name ry <br />rOwner <br />I f•� 1Jev.1 A �� G r2ci t'/ I a e. <br />Owner DBA <br />Owner Address }7 Rp.- <br />20 dhCKSOtl OetvE <br />NEWARK NI 07105- <br />NranatrrtT o�015 <br />Home Phone 973-589-6853 <br />Work/Business Phone 908-276-4000 <br />Mailing Address 20 JACKSON ST <br />CRANFORD, NJ 07016 <br />Care of <br />FACILITY FILE INFORMATION <br />Site Mitigation Facility <br />Facility ID FA0002715 <br />Facility Name <br />P _ NebiA2y-ZEc�C.t.t;D ice <br />Location 800 W CHURCH ST <br />STOCKTON, CA 95203 <br />Phone 209.466.525 <br />&69- log{- (0,510 <br />Mailing Address PO -Bo)( -6 44 <br />7S -4S (yRAPli 4.)^L, G% -VD STY o2U <br />smCymla, QA 9 So.) D'� <br />Care of <br />Location Code 01 - STOCKTON <br />Alt Phone cZU9� G- 10 <br />BOS District 001 - VILLAPUDUA <br />Fax <br />APN 14523004 <br />EMall: +o Lis, eon <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />rJ <br />Contact Name JESUS JIMENEZ <br />Title PLANT MANAGER <br />Day Phone 209-464-6590 <br />Night Phone 209-466-5252 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0004498 <br />New Account ID: <br />Mail Invoices to Facility <br />Mail Invoices to: Owner / Facility / Account <br />Account Name NEWARK SIERRA PAPERBOARD <br />CORP (Circle One) <br />Account Balance as of 8/11/2011: $0.00 <br />(Circle One) <br />Program/Elemara and Description Record ID <br />Transfer to Active/Inactve <br />Employee ID and Name Status New Owner? Delete <br />2220 SM HW GEN <5 TONS/YR PR0220074 <br />EE0001421 - STACY RIVERA Active Y N A I D <br />2224- HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511383 <br />EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2226 - CalARP PROGRAM PRO514526 <br />EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2244 - PACT TRANSFER RECORD - OES PR0519379 <br />EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0231063 <br />- EE0000418 - MICHAEL KITH Inactive Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARFIR0507317 <br />EE0000418- MICHAEL KITH Inactive Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHPRO534549 <br />Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge Brat 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 witi be performed in accordance with all applicable Ordinate Codes and/or Standards and <br />State anilfor Federal L 7 �0 <br />22:2 <br />APPLICANTS �a" ` _ " --fy <br />SIGNATURE: <br />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: Date (P Account out: <br />COMMENTS: <br />\\eh-env\envision\reports\5021.rpt <br />