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Date run 7/30/2018 1:42:30PN 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 />OWNER FILE INFORMATION Number of facilities for this owner : 1 <br />Owner ID <br />OW0014248 <br />Owner Name <br />MICHAEL J BRENKWITZ <br />Owner DBA <br />MICHAEL J BRENKWITZ <br />OwnerAddress <br />3396 KENNER <br />Y N <br />TRACY, CA 95304 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-835-4539 <br />Mailing Address <br />3396 KENNER <br />PR0530959 EE0000753 - WILLY NG <br />TRACY, CA 95304 <br />Care of <br />A I D <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0017407 10186405 <br />Facility Name <br />MICHAEL J BRENKWITZ <br />Location <br />3396 KENNER <br />Federal Laws. <br />TRACY, CA 95304 <br />Phone <br />209-835-4539 x <br />Mailing Address <br />3396 KENNER <br />TRACY, CA 95304 <br />Care of <br />Michael Brenkwitz <br />Location Code <br />BOS District <br />APN <br />25506061 <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 <br />Mail Invoices to Account <br />Account Name MICHAEL J BRENKWITZ <br />Account Balance as of 7/30/2018: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transferto Active/lnactve <br />Program/Element and Description <br />Record ID Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />1958 - HM -Farm Operations <br />PR0525592 EE0002670 - MUNIAPPA NAIDU <br />Active <br />Y N <br />A g D <br />2221 - USED OIL ONLY - <5 TONS/YR <br />PR0539808 EE9999997 - TWO VACANT2 <br />Active <br />Y N <br />A D <br />2840 -AST EXEMPT FAC < 1,320 GAL <br />PR0530959 EE0000753 - WILLY NG <br />InactivE <br />Y N <br />A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI <br />PR0532670 <br />InactjvE <br />Y N <br />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 % /� 0 %�' Account out: <br />COMMENTS: <br />�,SE'� oN �S�Pe �ial'7 bYr S/i77�� p�y�U' �P rl/�►� �o Invoice#: <br />C>7Y►"f ,+/t,n1e� vt�l9vf��'S�5 �hU�✓.�fi CVJsPoSa/ 5r L-40S�1�. <br />