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Da a m+ 10/24/2003 3:42:33P SAN JUIN COUNTY ENVIRONMENTAL IIEA DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 10/24/2 03 <br />ewiu oeiauuvn canna: raanry iu FA0002715 <br />F L El <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0002052 <br />Owner Name <br />NEWARK SIERRA PAPERBOARD CORP <br />Owner DBA <br />NEWARK SIERRA PAPERBOARD CORP <br />Owner Address <br />800 W CHURCH <br />Phone <br />STOCKTON, CA 95203 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />908-276-4000 <br />Mailing Address 800 W CHURCH ST <br />STOCKTON, CA 95203 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0002715 <br />Facility Name <br />NEWARK SIERRA PAPERBOARD CORP <br />Location <br />800 W CHURCH ST <br />Active <br />STOCKTON, CA 95203 <br />Phone <br />209-466-5251 <br />Mailing Address <br />03 <br />Care of <br />Location Code 01 -STOCKTON <br />BOS District 001 - GUTIERREZ, STEVE <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0004498 <br />Mail Invoices to Owner <br />Account Name NEWARK SIERRA PAPERBOARD CORP <br />Account Balance as of 10/24/2003: $0.00 <br />Program/Element and Descripbon Record ID <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511383 <br />2226 - CaIARP PROGRAM PRO514526 <br />2227 - GEN 5<25 TONS PERMIT PR0220074 <br />2244 -PACT TRANSFER RECORD - DES PR0519379 <br />2381 - UST FACILITY (BEFORE 1/84) PR0231063 <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE FPR0507317 <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />New Owner ID : <br />Site Mitigation Facility <br />PC (Bu 596q� <br />6anizL c&ra, aI-p5r, 2 -BU <br />APN: <br />SIC Code:9900 <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />Employee ID and Name <br />Status <br />Transfer to <br />New Owner? <br />Amount Paid <br />(Circle One) <br />Active/Inactve <br />Delete <br />EE0000000 - HAZ MAT SJC DES <br />Active <br />Y <br />N <br />A <br />I D <br />EE0000000 - HAZ MAT SJC OES <br />Active <br />Y <br />N <br />A <br />I D <br />EE0008844 - DINA ABATE <br />Active <br />Y <br />N <br />A <br />I D <br />EE0000000 - HAZ MAT SJC OES <br />Active <br />Y <br />N <br />A <br />I D <br />EE0000418 - MICHAEL KITH <br />Inactive <br />Y <br />N <br />A <br />I D <br />EE0000418 - MICHAEL KITH <br />Inactive <br />Y <br />N <br />A <br />I D <br />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 <br />facility or activity will be billed to the party Identified as the OWNER on this fame. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br />State and/or Federal Laws. , <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: ` $20.00 = <br />Amount Paid <br />Water System to be TRANSFERED: ' $155.00 = <br />Amount Paid <br />Number <br />Payment TypeTM. <br />�Check <br />REHS: SEq&'C Date / <br />/ A3 Account out: <br />COMMENTS: <br />qtr vt,tfd wi yn� <br />\\Phs-ehsql-nt\apps\Envisions\Reports\5021. rpt <br />Date <br />Date <br />Date <br />Re y <br />