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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 1/25/2016 Submitted on: 12/14/2015 2:21:10PM CERS ID: 10182953 Submitted by: Brad Mettler Email: Brad. Mettler@stocktonca.gov Facility ID in CERS: FA0009847 OWNER INFORMATION Owner ID Owner name Mailing address Work phone Information prior to CIW processing (current EC database) Number of Facilities for this Owner: 10 OW0007847 CITY OF STOCKTON - PARKS & REC 6 E LINDSAY ST STOCKTON, CA 95202-1997 209-937-8206 FACILITY FILE INFORMATION Facility ID FA0009847 Facility name STKN OAK PARK Site address 500 E ALPINE AVE City STOCKTON ZIP code 95204 Facility phone 209-937-8257 Facility mailing address 605 N EL DORADO ST STOCKTON, CA 95202-1997 BILLING INFORMATION Contact name City of Stockton CS Recreation Div Address 605 N EI Dorado Street STOCKTON, CA 95202-19 Contact phone 209-937-8257 Contact email Carolyn.Godwin@stocktongov.com Mail invoices to Account Information after CIW processing CERS (current submittal) field CITY OF STOCKTON - Community Servic 111 605 N EI Dorado Street 113 STOCKTON, CA 95202-1997 114, 115, 116 209 937 8257 112 STKN OAK PARK 3 500 E ALPINE AVE/3537 Alvarado street A 103 STOCKTON 104 95204 105 209 937-8257 102 605 N ELDORADO ST 108a STOCKTON, CA 95202-1997 108b, 108c, 108d City of Stockton CS Recreation Div 140 605 N EI Dorado Street 143 STOCKTON, CA 95202-19 144, 145, 146 209 937 8257 141 Carolyn.Godwin@stocktongov.com 142 Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PR#: _ New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: Date: Accounting: Reviewed by: L4 Date. I � � I Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] Acct billed [ ] Surcharge verified By: Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 1921 - HMBP-Regular-Primary Location PR0519914 HAZA SAEED Active [ ] [ ] 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509847 HAZ MAT SJC OES Inactive [ ] [ ] ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PRO531539 not assigned Inactive [ ] [ ]