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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run:417/2015 <br /> Submitted on: 2/4/2015 11:53:21AM CERS ID: 10182823 <br /> Submitted by: Eric Breitstein Email: coxbrostire@yahoo.com Facility ID in CERS: FA0009644 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0007644 <br /> Owner name BREITSTEIN, EARL / BREITSTEIN, ERIC EARL 111 <br /> Mailing address 525 SILVER LAKE DR 3063 CASTLE ROCK LOOP 113 <br /> DANVILLE, CA 94526 DISCOVERY BAY, CA 94505 114, 115,116 <br /> Work phone (209)835-0880 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009644 <br /> Facility name COX BROS TIRE SERVICE COX BROS TIRE SERVICE 3 <br /> Site address 507 E ELEVENTH ST 507 E ELEVENTH ST 103 <br /> City TRACY TRACY 104 <br /> ZIP code 95376 95376 105 <br /> Facility phone 209-835-0880 (209)835-0880 102 <br /> Facility mailing address 507E 11TH ST 507 E 11TH ST 108a <br /> TRACY, CA 95376 TRACY, CA 95376 108b, 108c.load <br /> BILLING INFORMATION <br /> Contact name COX BROS TIRE SERVICE / COX BROS TIRE SERVICE 140 <br /> Address 507 E 11TH ST / 507 E 11TH ST 143 <br /> TRACY, CA 95376 TRACY, CA 95376 144, 145, 146 <br /> Contact phone Not Specified (209)835-0880 141 <br /> Contact email142 <br /> Mail invoices to II a- <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: peel Date: 41-7145- <br /> ------------------------- ----------------- <br /> Accounting: <br /> I71/S-------------- <br /> ----------- <br /> Accounting: Reviewed by: 7 'r Date: S 1f $— Clerical: [ ] FileRelabel file <br /> [ ] [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified 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 PRO519798 MICHAEL PARISSI Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PRO513945 THUY TRAN Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522387 HARPRIT MATTU Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509644 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534612 not assigned Inactive [ ] [ ] <br />