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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/15/2015 <br /> Submitted on: 1/2/2015 4:13:03PM CERS ID: 10400443 <br /> Submitted by: Manzo Manzo Email:jcelprimo@gmail.com Facility ID in CERS: incorrect <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0017719 <br /> Owner name Juan Carlos Cervamtes Juan Carlos Cervamtes 111 <br /> Mailing address 408 S. Los Angeles St. 735 Virginia at 113 <br /> Stockton, CA 95203 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 E[ Primo Auto Dismantle EI Primo Auto Dismantle 3 <br /> Site address 1121 E Dr Martin Luther King Jr Blvd 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 209-941-2180 102 <br /> Facility mailing address 1121 E DR Martin Luther King Blvd JR 1121 E DR Martin Luther King Blvd JR 108a <br /> Stockton, CA 95205 Stockton, CA 95205 108b,10ec,108d <br /> BILLING INFORMATION <br /> Contact name Juan Carlos Cervantes Juan Carlos Cervantes 140 <br /> Address 1121 E DR Martin Luther King Blvd JR 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 ^ / jcelprimo@gmail.com 142 <br /> Mail invoices to _ /- <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ j prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by:_A Date: <br /> -------------- <br /> Accounting: Reviewed by: 3 O Clerical: [l�!File [ ] Relabel file [ ] Create new file <br /> Date: /1 ��� V <br /> [ ] Acct billed [ ] Surcharge verl led By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials PRO537470 ROBERT LOPEZ Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PRO537469 STACY RIVERA Active [ ] [ ] <br />