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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/29/2016 <br /> Submitted on: 11/21/2016 11:37:26AM CERS ID: 10182523 <br /> Submitted by: Surin Manivanh Email: mgarage209@gmail.com Facility ID in CERS: FA0009218 <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 <br /> Owner ID OW0007218 <br /> Owner name Surin Manivanh Surin Manivanh 111 <br /> Mailing address 2461 HOLLY DR 2461 HOLLY DR 113 <br /> TRACY, CA 95376-2128 TRACY, CA 95376-2128 114, 115, 116 <br /> Work phone 209-597-5522 2095975522 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009218 <br /> Facility name M-garage M-garage 3 <br /> Site address 2461 N HOLLY DR 2461 HOLLY DR 103 <br /> City TRACY TRACY 104 <br /> ZIP code 95376-2120 95376-2120 105 <br /> Facility phone 209-597-5522 2095975522 102 <br /> Facility mailing address 2461 HOLLY DR 2461 HOLLY DR 108a <br /> TRACY, CA 95376-2128 TRACY, CA 95376-2128 108b,10ac,108d <br /> BILLING INFORMATION <br /> Contact name M-garage Surin Manivanh 140 <br /> Address 2461 N HOLLY DR 2461 HOLLY DR 143 <br /> TRACY, CA 95376-2120 TRACY, CA 95376-2128 144, 145, 146 <br /> Contact phone 209-597-5522 2095975522 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG 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 c dar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: 11112gl1y <br /> - - - - - - - <br /> Accounting: Reviewed by: � Date: (I ['30 11 (, Clerical: [ ] File [ ] Relabel file [ ] 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 PR0519471 PETER LOMBARDI Active [ ] ( ] <br /> 2220-SM HW GEN<5 TONS/YR PRO513707 HERLINDA MENCHACA Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511506 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0509218 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531852 not assigned Inactive [ ] [ ] <br />