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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/9/2017 <br /> Submitted on: 9/20/2017 3:04:02PM CERS ID: 10400443 <br /> Submitted by: ana andrade Email: andradeanac20l5@gmail.com Facility ID in CERS: FA0021554 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 5 <br /> Owner I Juan Ca 719 YVQ 1t�C <br /> Owner name Juan Carlos Cervantes Juan Carlos ervamte 111 <br /> Mailing address 735 Virginia st 735 Virginia 113 <br /> Manteca, CA 95336 Manteca, CA 95336 114, 115, 116 <br /> Work phone 209-244-8160 209-244-8160 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021554 <br /> Facility name EI Primo Auto Dismantle EI Primo Auto Dismantle 3 <br /> Site address 1121 E DR MARTIN LUTHER KING JR BLV 1121 E Dr Martin Luther King Jr Blvd 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone 209-941-2180 209-905 3330 102 <br /> Facility mailing address 1121 E DR Martin Luther King Jr Blvd 1121 E DR Martin Luther King Blvd JR 108a <br /> Stockton, CA 95205 Stockton, CA 95205 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name EI Primo Auto Dismantle Juan Carlos Cervantes 140 <br /> Address 1121 E DR Martin Luther King Jr Blvd 1121 E DR Martin Luther King Blvd JR 143 <br /> Stockton, CA 95205 Stockton, CA 95205 144, 145, 146 <br /> Contact phone 209-244-8160 209-244-8160 141 <br /> Contact email jcelprimo@gmail.com elprimoauto2015@gmail.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW 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: Ili� Date: �—cilt <br /> i <br /> Accounting: Reviewed by: bfo� Date: /I l q'l7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ---------- - - - - - <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials 3 chem units PR0537470 ROBERT LOPEZ Active [ ] I ] <br /> 2220-SM HW GEN<5 TONSNR PR0537469 THREE VACANT3 Active [ ] <br /> o p [ ] <br /> in 04g tne <br /> (( 'tek Q)Ur t0 Csr1e� F CYV ftL1bhi <br />