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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 12129/2016 <br /> Submitted on: 12/28/2016 10:00:31AM CERS ID: 10184061 <br /> Submitted by:jim kruse Email:jkruse@hacsj.com Facility ID in CERS: FA0011046 <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: 2 <br /> Owner ID OW0009045 <br /> Owner name HOUSING AUTHORITY OF SJ COUNTY HOUSING AUTHORITY OF SJ COUNTY 111 <br /> Mailing address 421 S EI Dorado St j m X21 5. &1,7ora.dr7 ST 113 <br /> STOCKTON, CA 95203 STOCKTON, CA 9620#-044`7 114, 115, 116 <br /> Work phone 209-460-5063 2094605063 gsyp�5 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0011046 <br /> Facility name HOUSING AUTHORITY CO OF SJ Sierra Vista Homes HACSJ 3 <br /> Site address 2424 S BELLEVIEW ST 2424 S BELLEVIEW ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95206 95206 105 <br /> Facility phone 209-460-5000 (209)670-4757 102 <br /> Facility mailing address PO BOX 447 421 S EI Dorado St 108a <br /> STOCKTON, CA 952010447 Stockton, CA 95203 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name HOUSING AUTHORITY CO OF SJ HOUSING AUTHORITY CO OF SJ 140 <br /> Address PO BOX 447 4)4 5. 61IDqrAdPSr- 143 <br /> STOCKTON, CA 952010447 Stockton, CA 95203 144, 145, 146 <br /> Contact phone Not Specified 209 460-5063 141 <br /> Contact email jkruse@hacsj.com 142 <br /> Mail invoices to Faci' A- <br /> Program record [ ] H BP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST 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: '�AA Date: "�Z'�°[ 1(:51 <br /> -------- ---------------------------------------- <br /> Accounting: <br /> ------ ------- -------- <br /> Accounting: Reviewed by: I Date: 3b 1 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date_ <br /> — <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> VV 921 -HMBP-Regular-Primary Location 2 chem units PRO520631 , ROBERT LOPEZ Active [ ] [ ] <br /> 220-SM HW GEN 15 TONSIYR _- � PR0514505 ONE VACANT1 (Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513334 HAZ MAT SJC OES Inactive L l [ 1 <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511046 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO531190 STACY RIVERA Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534314 not assigned Inactive [ ] [ ] <br /> t. � NSA � M L ,,••� PM �5 <br />