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SAN JOAQUINLe6UNTY ENVIRONMENTAL HEALTI-t*bARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/2/2014 <br /> :r <br /> Submitted on: 2/27/2013 9:08:49PM ERS ID: 1018768 <br /> Submitted by: ROBERT TAYLOR Email: taylorauto05@yahoo.com Facility ID in 0020757 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013420 <br /> Owner name TAYLOR, ROBERT B TAYLOR, ROBERT B, 111 <br /> Mailing address 18711 MONTE VISTA OR 3373 HEATHERBROOK DR. 113 <br /> LINDEN, CA 95236 STOCKTON, CA 952.19 114, 115, 116 <br /> Work phone 209-227-5077. 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0020757 <br /> Facility name TAYLOR AUTOMOTIVE INC TAYLOR AUTOMOTIVE INC 3 <br /> Site address 3932 E FREMONT ST 3932 E FREMONT ST 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 95215 95215 105 <br /> Facility phone 209-931-6007 (209) 931-6007 102 <br /> Facility mailing address 3932 E FREMONT ST 3932 E FREMONT ST 108a <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 108b,108c,108d <br /> BILLING INFORMATION I <br /> Contact name TAYLOR AUTOMOTIVE INC TAYLOR AUTOMOTIVE INC 140 <br /> Address 3932 E FREMONT ST 3932 E FREMONT ST 143 <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 144, 145, 146 <br /> Contact phone 209-931-6007 209-931-6007 141 <br /> Contact email 142 <br /> Mail invoices to Facility <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 [ ] prorate this calendar year. [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> — <br /> Accounting: Reviewed by: Date Clerical: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 /> Program Element and Description Record ID Em to ee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials PR0536317 ROBERT LOPEZ Active [ ] [ ] <br /> 2220--SM HW GEN<5 TONSIYR PR0536125 JEFFREY WONG Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PRO536126 not assigned Inactive [ ] [ l <br /> F <br />