Laserfiche WebLink
SAN JOAQUIWtOUNTY ENVIRONMENTAL HEALTHMEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/25/2014 <br /> Submitted on: 2/25/2013 11:27:10AM CERS ID: 10414963 <br /> Submitted by: Michael Robinson Email: mike.robinson@amr.net Facility ID in CERS: <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION <br /> (current EC database) (current submittal) field <br /> Owner ID OW0019880 <br /> Owner name AMERICAN MEDICAL RESPONSE AMERICAN MEDICAL RESPONSE 111 <br /> Mailing address 400 FRESNO AVE 400 FRESNO AVE 113 <br /> 11a, 115 11s <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 <br /> Work phone 209-948-5136 (209) 948-5136 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022455 <br /> Facility name American Medical Response American Medical Response 3 <br /> Site address 455 W Beverly PI 455 W Beverly PI 103 <br /> City Tracy Tracy 104 <br /> Zip code 95376 95376 105 <br /> Facility phone 209-948-5136 (209) 948-5136 102 <br /> Facility mailing address 400 FRESNO AVE 400 FRESNO AVE 108a <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 108b,1oac,load <br /> BILLING INFORMATION <br /> Contact name AMERICAN MEDICAL RESPONSE AMERICAN MEDICAL RESPONSE 140 <br /> Address 400 FRESNO AVE 400 FRESNO AVE 143 <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 144, 145, 146 <br /> Contact phone 209-948-5136 (209) 948-5136 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record (<D HMBP [ ] 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: Dater <br /> --- --- —._p-------------------------- <br /> Accounting: Reviewed by: )ate: Clerical: [ ] File ( ] Relabel file [ ] Create new file <br /> Acct billed ----- -------- Date_--- <br /> ----- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMP-Regular-Primary Location PRO539267 ROBERT LOPEZ Active [ ] [ ] <br /> pet-,-) <br /> 1 <br />