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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/7/2016 <br />Submitted on: 1/4/2016 8:31:10AM <br />Submitted by: Regina Metzker Email: rmetzker@kpaonline.com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner: 2 <br />OW0005820 <br />Paul J Umdenstock <br />PO BOX 690398 <br />STOCKTON, CA 95269 <br />209-956-5244 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0016202 <br />Facility name <br />BIG VALLEY FORD LINCOLN <br />Site address <br />2929 AUTO CENTER CIR <br />City <br />STOCKTON <br />ZIP code <br />95212 <br />Facility phone <br />209-870-4400 <br />Facility mailing address <br />PO BOX 690398 <br />STOCKTON, CA 95212 <br />BILLING INFORMATION <br />Contact name <br />BIG VALLEY FORD LINCOLN <br />Address <br />PO BOX 690398 <br />STOCKTON, CA 95212 <br />Contact phone <br />209-870-4400 <br />Contact email <br />Mail invoices to <br />Account <br />CERS ID: 10185111 <br />Facility ID in CERS: FA0016202 <br />Information after CIW processing CERS <br />(current submittal) field <br />Paul Umdenstock 111 <br />7120 Lincoln Oaks Rd 113 <br />Stockton, CA 95207 114, 115, 116 <br />209-870-4400 112 <br />BIG VALLEY FORD LINCOLN 3 <br />2929 AUTO CENTER CIR 103 <br />STOCKTON 104 <br />95212 105 <br />209-870-4400 102 <br />PO BOX 690398 108a <br />STOCKTON, CA 95212 108b, 108c, 108d <br />BIG VALLEY FORD LINCOLN 140 <br />PO BOX 690398 143 <br />STOCKTON, CA 95212 144, 145, 146 <br />209-870-4400 141 <br />142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: '/' kA Date: <br />Accounting: Reviewed by: U�> Date: J11 /4., Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated Inactivated <br />921 - HMBP-Regular-Primary Location PR0524111 JAMIE DE LA ROSA Active (] ( ] <br />2227 - GEN 5<25 TONS PERMIT PR0527711 FATINAH ZAREEF Active [ ] [ ] <br />4740 - WASTE TIRE SITE - EXEMPT PR0527170 NATALIA SUBBOTNIKOVA Active [ l [ 1 <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0536036 not assigned Inactive [ ] [ ] <br />