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Date run 8/4/2014 11:58:15AM SAN JO `JIN COUNTY ENVIRONMENTAL HEAT t DEPARTMENT Report#5021 <br /> Run by )W/ <br /> Facility Information as of 8/4/2014 Page <br /> Record Selection Criteria: Facility ID FA0009316 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN/Fed Tax ID <br /> Owner ID OW0007316 Case Number: H03062 New Owner ID <br /> Owner Name SMS BRINERS INC <br /> Owner DBA SMS BRINERS INC <br /> Owner Address 17750 E HWY 4 <br /> STOCKTON, CA 952159720 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 209-941-8515 <br /> Mailing Address 17750 E HWY 4 <br /> STOCKTON, CA 95215-9720 <br /> Care of KRUGER, DENNIS <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009316 10182587 <br /> Facility Name SMS BRINERS INC <br /> Location 17750 E HWY 4 <br /> STOCKTON. CA 95215 <br /> Phone 209-941-8515 x <br /> Mailing Address 17750 E HWY 4 <br /> STOCKTON, CA 95215-9720 <br /> Care of CHELLI, ROBERT <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 18314010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016316 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SMS BRINERS INC ccirae0.) <br /> Account Balance as of 8/4/2014: $0.00 <br /> (circle One) <br /> Transfer to Active/Inacbn, <br /> ProgramrElemsnt and Description Record ID Employee ID and Name Status New OvmeR Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519542 EE0000006-HAZA SAEED Active Y N A I D <br /> 1995-CaIARP FAC STATE SURCHARGE FEE PRO518997 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO513769 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511604 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509316 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534067 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project spec,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS 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 Received by <br /> REHS: Date_/ / Account out: Date_/ I <br /> COMMENTS: <br />