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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 2/8/2017 <br /> Submitted on: 2/2/2017 6:06:37PM CERS ID: 10182537 <br /> Submitted by: Niles Anderson Email: nilesanderson@sbcglobal.net Facility ID in CERS: FA0009238 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0007238 <br /> Owner name NILESANDERSON NILESANDERSON 111 <br /> Mailing address 3131 E ANITA ST 3131 E ANITA ST 113 <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 114, 115, 116 <br /> Work phone 209-943-1145 209-943-1145 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009238 <br /> Facility name ANDERSON MOULDS INC ANDERSON MOULDS INC 3 <br /> Site address 3131 E ANITA ST 3131 E ANITA ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone 209-943-1145 209-943-1145 <br /> 102 <br /> Facility mailing address 3131 E ANITA ST 3131 E ANITA ST 108a <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 108b,108c,toad <br /> BILLING INFORMATION <br /> Contact name DANIELLE PETERSON NILES ANDERSON 140 <br /> Address 3131 E ANITA ST 3131 E ANITA ST 143 <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 144, 145, 146 <br /> Contact phone 209-943-1145 209-943-1145 141 <br /> Contact email peterson_danielle@sbcglobal.net NIL ESANDERSON@SBCGLOBAL.NET 142 <br /> Mail invoices to Owner <br /> Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: �''-) t (c2o <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: 22-2-0 <br /> Assigned to: CAANC a-A 1 <br /> Please bill: 44] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Q\A Date: � ' ] <br /> --- -- ----- --- -- --- --- -- --- -- <br /> Accounting: Reviewed by: ��_Date: kAll 7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> I LAcct billed [ Surcharge verified g <br /> — __ -- _ / _ Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMBP-Regular-Primary Location 10 chem units PR0519485 ROBERT LOPEZ Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511526 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509238 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532326 not assigned Inactive [ ] [ ] <br /> (/JW ge? <br />