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Date run 7/30/2018 1:42:30Pfv SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/30/2018 <br /> Record Selection Criteria: Facility ID FA0017407 <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 OW0014248 New Owner ID <br /> Owner Name MICHAEL J BRENKWITZ <br /> Owner DBA MICHAEL J BRENKWITZ <br /> OwnerAddress 3396 KENNER <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-4539 <br /> Mailing Address 3396 KENNER <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017407 10186405 <br /> Facility Name MICHAEL J BRENKWITZ <br /> Location 3396 KENNER <br /> TRACY, CA 95304 <br /> Phone 209-835-4539 x <br /> Mailing Address 3396 KENNER <br /> TRACY, CA 95304 <br /> Care of Michael Brenkwitz <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 25506061 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 AR0030289 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MICHAEL J BRENKWITZ (Circle One) <br /> Account Balance as of 7/30/2018: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525592 EE0002670-MUNIAPPA NAIDU Active Y N A g D <br /> 2221 -USED OIL ONLY-<5 TONS/YR PR0539808 EE9999997-TWO VACANT2 Active Y N A D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0530959 EE0000753-WILLY NG InactivE Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532670 InactivE 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 and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S 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 b/ <br /> EHD Staff: Date 7 / 10 /� Accountout: <br /> COMMENTS: y� J / <br /> �iSC'�oN -SPC ffa17 bYr S/i77�� oJYI� �P TI/�1� �U Invoice#: <br /> GaY�f li��le� v>n6�e7��es�5 Sho;✓:ir► p�15�i7sa� b� r,Jcra'�P. <br />