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SAN JOAQUIltdOUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/25/2014 <br /> Submitted on: 2/28/2014 3:25:20PM CERS ID: 10182371 <br /> Submitted by: dennis cunnington Email: 50301odi@sbcglobal.net Facility ID in CERS: FA0009040 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0007040 <br /> Owner name DENNIS CUNNINGTON DENNIS CUNNINGTON 111 <br /> Mailing address 302 N CHEROKEE LN 302 N CHEROKEE LN 113 <br /> LOD], CA 95240 LODI, CA 95240 114,115,116 <br /> Work phone 209-368-8851 209-368-8851 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009040 <br /> Facility name BIG O TIRES#30 BRUGES TIRES ENT 3 <br /> Site address 302 N CHEROKEE LN 302 N CHEROKEE LN 103 <br /> City LODI LODI 104 <br /> Zip code 95240 95240 105 <br /> Facility phone 209-368-8851 (209) 368-8851 102 <br /> Facility mailing address 302 N CHEROKEE LN 302 N CHEROKEE LN 108a <br /> LODI, CA 95240 LODI, CA 95240 108b,toes,load <br /> BILLING INFORMATION <br /> Contact name BIG O TIRES#30 BRUCES TIRE ENT. 140 <br /> Address 302 N CHEROKEE LN 302 N CHEROKEE LN 143 <br /> LODI, CA 95240 LODI, CA 95240 144, 145, 146 <br /> Contact phone Not Specified 209-368-8851 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG 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 /> ------------------------ <br /> Accounting: Reviewed by:.— <br /> Date:� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acc led [ ] Surcharp�ven lef d 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 /> 1920-HMBP-Common Materials PR0519342 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN 45 TONSNR PR0513602 ARIS VELOSO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509040 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522299 HARPRIT MATTU Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PR0534699 not assigned Inactive [ ] [ ] <br />