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SAN JOAQUIM -COUNTY ENVIRONMENTAL HEALTA-6EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/8/2014 <br /> Submitted on: 3/4/2013 4:17:32PM CERS ID: 10186809 <br /> Submitted by: Lori Yadon Email: zorbcarwashes@sbcglobal.net Facility ID in CERS: FA0018158 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014901 <br /> Owner name MONTY ZORB/KELLY REILLY MONTY ZORB 111 <br /> Mailing address 7808 KELLEY DR STE F 7808 KELLEY DR STE F 113 <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 114, 115, 116 <br /> Work phone 209-474-5822 209-298-5750 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018158 <br /> Facility name KELLEYS EXPRESS CAR WASH KELLEYS EXPRESS CAR WASH 3 <br /> Site address 441 W CHARTER WAY 441 W CHARTER WAY 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 95206 95206 105 <br /> Facility phone 209-474-5822 (209)474-5822 102 <br /> Facility mailing address 7808 KELLEY DR STE F 7808 KELLEY DR STE F 108a <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 mab,loac,108d <br /> BILLING INFORMATION <br /> Contact name KELLEYS EXPRESS CAR WASH KELLEYS EXPRESS CAR WASH 140 <br /> Address 7808 KELLEY DR STE F 7808 KELLEY DR STE F 143 <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 144, 145, 146 <br /> Contact phone Not Specified 209-474-5822 141 <br /> Contact email 142 <br /> Mail invoices to Owner <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] 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 /> --------------- <br /> Accounting: Reviewed —Date: Clerical: FileRelabel <br /> file [ ] Create new file <br /> [ ] Accj bid [ ] Sp:hargTGenfied 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 /> 1921 -HMBP-Regular-Primary Location PR0526801 ROBERT LOPEZ Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PR0533146 not assigned Inactive [ ] [ ] <br />