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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 8/6/2018 <br />Submitted on: 2/5/2018 2:13:04PM <br />Submitted by: Lamara Torosyan Email: lamara.torosyan@redcross.org <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW <br />(current EC datat <br />Number of Facilities for this O, <br />OW0001860 <br />AMERICAN RED CROSS <br />100 RED CROSS CIR <br />POMONA, CA 91768 <br />209-943-3830 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0002435 <br />Facility name <br />DELTA BLOOD BANK <br />Site address <br />65 N COMMERCE ST <br />City <br />STOCKTON <br />ZIP code <br />95202 <br />Facility phone <br />888-942-2566 <br />Facility mailing address <br />100 RED CROSS CIR <br />PO BOX 800 <br />POMONA, CA 91768 <br />BILLING INFORMATION <br />114, 115, 116 <br />Contact name <br />American Red Cross <br />Address <br />100 RED CROSS CIR <br />5 N C <br />POMONA, CA 91768 <br />Contact phone <br />Not Specified <br />Contact email <br />104 <br />Mail invoices to <br />Account <br />CERS ID: 10180929 <br />Facility ID in CERS: FA0002435 <br />Information after C W processing CERS <br />(current suomittal) field <br />DELTA BLOOD BA LLC <br />111 <br />PO BOX 800 <br />113 <br />tockton, CA 95 1 <br />114, 115, 116 <br />( 09) 943-3830 <br />112 <br />meri n R d Cross <br />3 <br />5 N C <br />RCE ST <br />103 <br />STOCKT <br />104 <br />95202 <br />105 <br />(209) 94 -3 0 <br />102 <br />65 N C mmer a St. <br />108a <br />Stoc on, CA 5202 <br />108b, 108c, 108d <br />la Torosyan <br />140 <br />00 Red Cross Circ e <br />143 <br />Pomona, CA 91768 <br />144, 145, 146 <br />(818)797-5576 <br />141 <br />lamara.torosyan@redcr s.org <br />142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />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: a -%A Date: <br />Accounting: Reviewed by: (� Date: g1) g ' Clerical: [ ] File [ ] Relabel file [ ]Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location 2 chem units PR0530821 ROBERT LOPEZ Active [ ] [ ] <br />2220 - SM HW GEN <5 TONS/YR PR0518109 STACY RIVERA Active [ ] [ ] <br />4530 - LG QUANITY GENERATOR PR0450112 ROBERT MCCLELLON Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0518110 ONE VACANT1 Inactive [ ] [ ] <br />4557 - MED WASTE LIMITED HAULER PR0506421 ROBERT MCCLELLON Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0531672 not assigned Inactive [ ] [ ] <br />