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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 11/18/2016 <br /> Submitted on: 11/14/2016 3:07:16PM CERS ID: 10180755 <br /> Submitted by: Nicole Berg Email: nicole.berg@fmc-na.com Facility ID in CERS: FA0001467 <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 OW0013442 <br /> Owner name RENALADVANTAGE INC RENALADVANTAGE INC 111 <br /> Mailing address 3115 West March Lane 1550 W MCEWEN DR STE#500 113 <br /> Stockton, CA 95219 FRANKLIN, TN 37067 114, 115, 116 <br /> Work phone 209-955-7527 (209) 97 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001467 <br /> Facility name RAI - NO CALIFORNIA-STOCKTON RAI - NO CALIFORNIA-STOCKTON 3 <br /> Site address 2350 N CALIFORNIA ST 2350 N CALIFORNIA ST 103 <br /> City Stockton STOCKTON 104 <br /> ZIP code 95204 95204 105 <br /> Facility phone 209-943-0854 (209) 943-0854 102 <br /> Facility mailing address 2350 N CALIFORNIA ST 1550 W MCEWEN DR STE#500 108a <br /> STOCKTON, CA 95204 FRANKLIN, TN 37067 108b,108c, load <br /> BILLING INFORMATION <br /> Contact name RAI - NO CALIFORNIA-STOCKTON RAI - NO CALIFORNIA-STOCKTON 140 <br /> Address 2350 N CALIFORNIA ST 1550 W MCEWEN DR STE#500 143 <br /> STOCKTON, CA 95204 FRANKLIN, TN 37067 144, 145, 146 <br /> Contact phone Not Specified (209) 943-0854 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record [ ] 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: Date: <br /> Accounting: Reviewed by: tb Date: /I /8�/ 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 /> 1921 -HMBP-Regular-Primary Location PR0520532 HAZA SAEED Active [ ] [ ] <br /> 4530-LG QUANITY GENERATOR PR0450034 BENJAMIN ESCOTTO Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513170 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510882 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534593 not assigned Inactive [ ] [ ] <br />