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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/11/2016 <br />Submitted on: 1/8/2016 4:19:40PM <br />Submitted by: Allen Faass Email: afaass@unitedpacific.com <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 : 4 <br />OW0011808 <br />APRO LLC <br />17311 S. MAIN ST. <br />GARDENA, CA 90248 <br />310-323-3992 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0006438 <br />Facility name <br />United # 5446 <br />Site address <br />1403 W COUNTRY CLUB BLVD <br />City <br />STOCKTON <br />ZIP code <br />95204 <br />Facility phone <br />925-884-0800 <br />Facility mailing address <br />7180 Koll Center Pkwy <br />Pleasanton, CA 94566-3184 <br />BILLING INFORMATION <br />Contact name <br />Permits/License <br />Address <br />PO Box 5280 <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Pleasanton, CA 94566 <br />Contact phone <br />925-884-0800 <br />Contact email <br />APHelp@mygoodsmarket.com <br />Mail invoices to <br />Account <br />CERS ID: 10182103 <br />Facility ID in CERS: FA0006438 <br />Information after CIW processing CERS <br />(current submittal) field <br />AFRO LLC 111 <br />17311 S. MAIN ST. 113 <br />GARDENA, CA 90248 114, 115, 116 <br />310-323-3992 112 <br />United # 5446 3 <br />1403 W COUNTRY CLUB BLVD 103 <br />STOCKTON 104 <br />95204 105 <br />310-323-3992 102 <br />17311 S MAIN ST 108a <br />GARDENA, CA 90248 108b, 108c, 108d <br />MICHAEL SANCHEZ 140 <br />17311 S MAIN ST 143 <br />GARDENA, CA 90248 144, 145, 146 <br />310-323-3992 141 <br />MSANCHEZ@UNITEDOILCO,COM 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 [ ] <br />next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: <br />Accounting: Reviewed by: Date: vl! Clerical: <br />[ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified <br />By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name <br />Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location PR0519640 HAZA SAEED <br />Active [ ] [ ] <br />2220 - SM HW GEN <5 TONSNR PR0521815 FATINAH ZAREEF <br />Active [ ] [ ] <br />2361 - UST FACILITY PR0231995 FATINAH ZAREEF <br />Active [ ] [ l <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507627 MICHAEL KITH <br />Inactive [ ] [ ] <br />2950 - ENVIRON ASSESS PR0505513 MICHAEL INFURNA <br />Inactive [ J [ ] <br />3123 - STORMWATER INSPECTION - RETAIL GAS OUTLET PR0523000 GARRETT BACKUS <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PRO534473 not assigned <br />Inactive <br />