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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 2/26/2015 <br /> Submitted on: 1/14/2015 4:31:14PM CERS ID: 10184211 <br /> Submitted by: Carey Cumberlege Email: gcumberleg@aol.com Facility ID in CERS: FA0012386 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0007783 <br /> Owner name BRANNON, C/CUMBERLEGE, C BRANNON, C/CUMBERLEGE, C 111 <br /> Mailing address PO BOX 1988 PO BOX 1988 113 <br /> STOCKTON, CA 95201 STOCKTON, CA 95201 114, 115,116 <br /> Work phone 209-466-1881 2094661881 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012386 <br /> Facility name BRANNON TIRE BRANNON TIRE -CLAREMONT 3 <br /> Site address 4905 CLAREMONT 4905 CLAREMONT 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-477-9000 (209)477-9000 102 <br /> Facility mailing address PO BOX 1988 PO BOX 1988 108a <br /> STOCKTON, CA 95201 STOCKTON, CA 95201 10eb, 108c, 10ed <br /> BILLING INFORMATION <br /> Contact name BRANNON TIRE BRANNON TIRE 140 <br /> Address PO BOX 1988 PO BOX 1988 143 <br /> STOCKTON, CA 95201 STOCKTON, CA 95201 144, 145, 146 <br /> Contact phone Not Specified 2094661881 141 <br /> Contact emailQCUMBERLEG@AOL.COM 142 <br /> Mail invoices to GF0iW V/ <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRAHW 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: 0✓M Date: <br /> Accounting: y Reviewed b : Date:!/13 / Clerical: [ ] File <br /> [ ] 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 PR0520924 HAZA SAEED Active [ ] [ ] <br /> 2227-GEN 5<25 TONS PERMIT PR0516229 FATINAH ZAREEF Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO522554 TED TASIOPOULOS Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO515934 SITE UNASSIGNED Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532934 not assigned Inactive [ ] [ ] <br />