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E- SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/19/2014 <br /> Submitted on: 5/13/2014 2:00:22PM CERS ID: 10180605 <br /> Submitted by: Kiumars Khajevandi Email: kkhajevandi@att.net Facility ID in CERS: FA0000485 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0005718 <br /> Owner name AMIRI, HALEH BOKIDES FAMILY LTD 111 <br /> Mailing address 1809 SCHOOL ST PO BOX 1411 113 <br /> MORAGA, CA 94556 WOODRIDGE, CA 95258 114, 115,116 <br /> Work phone 209-334-1873 (209) 334 0975 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000485 <br /> Facility name FLAG CITY CHEVRON FLAG CITY CHEVRON 3 <br /> Site address 6421 CAPITOLAVE 6421 CAPITOLAVE 103 <br /> City LODI LODI 104 <br /> Zip code 95242 95242 105 <br /> Facility phone 209-334-1873 (209) 334-1873 102 <br /> Facility mailing address 6421 CAPITOL AVE 6421 CAPITOLAVE 108a <br /> LODI, CA 95242 LODI, CA 95242 108b, 108c.coed <br /> BILLING INFORMATION <br /> Contact name FLAG CITY CHEVRON FLAG CITY CHEVRON 140 <br /> Address 6421 CAPITOLAVE 6421 CAPITOLAVE 143 <br /> LODI, CA 95242 LODI, CA 95242 144, 145. 146 <br /> Contact phone 209-334-1873 (209) 334 0975 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: �'MIJ Date: 1;°-t�' <br /> Accounting: Reviewed by: Date:/f�// [[`t Clerical: File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] SurcF�acg�werified� By: Date: <br /> ---- - - <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> ✓1615-RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PREP] PRO160308 NICHOLAS WIESEMAN Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0520517 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO519074 ARIS VELOSO Active [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PRO515536 MICHAEL KITH Inactive [ ] [ ] <br /> 2361 -UST FACILITY PR0231706 ARIS VELOSO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507248 MICHAEL KITH Inactive [ ] [ ] <br />