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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 3/31/2017 <br />Submitted on: 3/9/2017 11:16:20AM CERS ID: 10195759 <br />Submitted by: Leland Lefebvre Email: Ilefebvre@bakerdist.com Facility ID in CERS: FA0011113 <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner: 1 <br />OW0009113 <br />Baker Distributing Company <br />14610 Breakers Drive <br />Jacksonville, FL 32258 <br />904-407-4499 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0011113 <br />Facility name <br />Baker Distributing Branch 600 <br />Site address <br />25882 S Corporate Ct <br />City <br />Tracy <br />ZIP code <br />95377 <br />Facility phone <br />203-833-3705 <br />Facility mailing address 25882 S. Corporate Ct <br />Information after CIW processing CERS <br />(current submittal) field <br />Baker Distributing Company 111 <br />14610 Breakers Drive 113 <br />Jacksonville, FL 32258 114, 115, 116 <br />904-407-4499 112 <br />Baker Distributing Branch 600 3 <br />25882 S Corporate Ct 103 <br />Tracy 104 <br />95377 105 <br />203-833-3705 102 <br />25882 S. Corporate Ct 108a <br />Tracy, CA 95377 108b, 108c, 108d <br />Jennifer Wilson <br />Tracy, CA 95377 <br />BILLING INFORMATION <br />143 <br />Contact name <br />Jennifer Wilson <br />Address <br />14610 Breakers Drive <br />jenniferw@bakerdist.com <br />Jacksonville, FL 32258 <br />Contact phone <br />904-407-4367 <br />Contact email <br />jenniferw@bakerdist.com <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />Baker Distributing Company 111 <br />14610 Breakers Drive 113 <br />Jacksonville, FL 32258 114, 115, 116 <br />904-407-4499 112 <br />Baker Distributing Branch 600 3 <br />25882 S Corporate Ct 103 <br />Tracy 104 <br />95377 105 <br />203-833-3705 102 <br />25882 S. Corporate Ct 108a <br />Tracy, CA 95377 108b, 108c, 108d <br />Jennifer Wilson <br />140 <br />14610 Breakers Drive <br />143 <br />Jacksonville, FL 32258 <br />144, 145, 146 <br />904-407-4367 <br />141 <br />jenniferw@bakerdist.com <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 [ 2] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: �o�'''`— Date: <br />Accounting: Reviewed by: Date: 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 Inactiv d <br />1921 - HMBP-Regular-Primary Location 4 chem units PR0520678 NICHOLAS LOEHRER Active [ ] <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513401 HAZ MAT SJC OES Inactive [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511113 HAZ MAT SJC OES Inactive [ ] [ ] <br />4740 - WASTE TIRE SITE - EXEMPT PR0535348 ALFONSO ARAMBULA Inactive (] [ ] <br />rM� ;1V4,9t !3 ret-vvA o�x, Per Con.,,,,,e„� Lk-\ 5..� n,�yv�.�v,. Oar'\ '�•3I -�7 <br />