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Date run 5/15/2009 1:31:23PK SAN JUIN COUNTY ENVIRONMENTAL HEW DEPARTMENT Report #5021 Run by zoe5 Pagel Facility Information as of 5/15/ Cmena: Facility ID OWNER FILE INFORMATION Owner ID OW0002052 Owner Name NEWARK GROUP INDUSTRIES Owner DBA Owner Address 17 BLANCHARD NEWARK, NJ 07105 Home Phone 973-589-6853 Work/Business Phone 908-276-4000 Mailing Address 20 JACKSON ST CRANFORD, NJ 07016 Care of FACILITY FILE INFORMATION Facility ID FA0002715 Facility Name NEWARK SIERRA PAPERBOARD CORP Location 800 W CHURCH ST 6 - CalARP PROGRAM PRO514526 STOCKTON, CA 95203 Phone 209-466-5251 Mailing Address PO BOX 58044 PACT TRANSFER RECORD - DES PRO519379 SANTA CLARA, CA 950528044 Care of 2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0231063 Location Code 01 - STOCKTON BOS District 001 - VILLAPUDUA APN 14523004 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0004498 Mail Invoices to Facility Account Name NEWARK SIERRA PAPERBOARD CORP Account Balance as of 5/15/2009: $3,368.00 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN / Fed Tax ID New Owner ID : _ S 2d�17 `i Z Site Mitigation Facility Fax EMail : 1 New Account ID: : Mail Invoices to: Owner / Facility / Account (Circle one) (circle One) Transfer to Active/InecNe Pmgram/Element and Description Record 10 Employee 10 and Name Status Nev, Owner? Delete 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511383 EE0000000 - HAZ MAT SJC OES Inactive Y N - A I D 6 - CalARP PROGRAM PRO514526 EE0000000 - HAZ MAT SJC DES Inactive Y N A I D 222 GEN 5<25 TONS PERMIT PR0220074 EE0008317 - RAYMOND VON FLUE Active Y N A I D PACT TRANSFER RECORD - DES PRO519379 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D 2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0231063 EE0000418 - MICHAEL KITH Inactive Y N A I D 2399 - UNIFIED PROGRAM FAC STATE SURCHARPR0507317 EE0000418 - MICHAEL KITH Inactive Y N A 1 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 will be in accordance with all applicable Ordinance Codes and/or Standards and facility or activity vri11 be billed to the parry idemified as the OWNER on this form. I also certify that all operations performed State andtor Federal Laws.�� `I 0� 4D Pin et ^ � r G !j!� P It testi G APPLICANTS SIGNATURE: Date II Program Records to be TRANSFERED: ' $20.00 = Amount Paid Date Water System to be TRANSFERED: -*$372.00= Amount Paid Date Payment T e Check N er Race! v Date) REHS: Date I / Account out: 5;ZL/�-a COMMENTS: - � \\eh-env\envision\reports\5021.rpt