Laserfiche WebLink
Date run 3/4/2016 8:31:19AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/4/2016 <br /> Record Selection Criteria: Facility ID FA0012370 <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 OW0009597 New Owner ID <br /> Owner Name BRANDT, MICHAEL <br /> Owner DBA MICHAEL BRANDT <br /> Owner Address 910 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-365-9694 <br /> Mailing Address 910 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0012370 10184203 <br /> Facility Name SAN JOAQUIN CHROME <br /> Location 916 BLACK DIAMOND WAY STE A <br /> LODI, CA 95240 <br /> Phone 209-365-9694 x <br /> Mailing Address 910 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Care of Mike Brandt <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 04917016 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMAT N <br /> Account ID AR0020224 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SAN JOAQU N CHROME (Circle One) <br /> Account Balance as of 3/4/2016 $248. 0 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1925-HMBP-Multisite Secondary Location PR0520939 EE0008709-JAMIE DE LA ROSA Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PRO540557 EE0001422-ARIS VELOSO Active Y N A( I ) D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0515899 EE0000000-HAZ MAT SJC OES InactivE Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO515900 EE0009999-SITE UNASSIGNED InaCtlVE Y N A 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 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 anc/or Standards and State ancLor <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE. Date ! / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> ater System to be TRANSFERED: Amount Paid Date <br /> ayment Type Check Number Received by <br /> HD Staff: a Date iz 7:3, Account out: Date <br /> OMMENTS: <br /> Invoice#: <br /> Cdr& <br /> s Ira �0 �C�s <br />