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SAN JOAQUAlCOUNTY ENVIRONMENTAL HEALTF"hiiiii'ltPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/24/2014 <br /> Submitted on: 6/2/2014 11:35:13AM CERS ID: 10183615 <br /> Submitted by: LYNELL YOUNGBLOOD Email: LYNELL@DYNOMASTERINC.COM Facility ID in CERS: FA0010524 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0008524 <br /> Owner name YOUNGBLOOD, ROBERT YOUNGBLOOD, ROBERT 111 <br /> Mailing address 10830 S HARLAN RD 10830A S HARLAN RD 113 <br /> FRENCH CAMP, CA 952319600 FRENCH CAMP, CA 95231-9600 114,115, 116 <br /> Work phone 209-234-1963 209 234 1963 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010524 <br /> Facility name DYNOMASTER INC DYNOMASTER INC 3 <br /> Site address 10830 S HARLAN RDA 10830A S Harlan Rd 103 <br /> City FRENCH CAMP French Camp 104 <br /> Zip code 95231 95231 105 <br /> Facility phone 209-234-1963 (209)234-1963 0 102 <br /> Facility mailing address 10830 S HARLAN RD 10830A S HARLAN RD 108a <br /> FRENCH CAMP, CA 952319600 FRENCH CAMP, CA 95231-9600 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name DYNOMASTER INC LYNELL YOUNGBLOOD 140 <br /> Address 10830 S HARLAN RD 10830A S HARLAN RD 143 <br /> FRENCH CAMP, CA 952319600 FRENCH CAMP, CA 95231-9600 144, 145, 146 <br /> Contact phone Not Specified 209 234 1953 141 <br /> Contact email LYNELL@DYNOMASTERINC.COM 142 <br /> Mail invoices to Owner <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ J 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: Date: 4 a� l <br /> Accounting: Reviewed by: _ Date: — 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 Employee name Status Reactivated lnacUv d <br /> 1920-HMBP-Common Materials PR0512812 JAMIE DE LA ROSA Active [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0539469 THUY TRAN Active [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510524 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531412 not assigned Inactive [ ] [ ] <br />