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SAN JOAQUTA.COUNTY ENVIRONMENTAL HEALTH`atEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/25/2014 <br /> Submitted on: 3/5/2014 9:26:03AM CERS ID: 10182635 <br /> Submitted by: Douglas Rose Email: drose@kustomkurves.com Facility ID in CERS: FA0009370 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0007370 <br /> Owner name ROSE, DOUG ROSE, DOUG 111 <br /> Mailing address 4 N HOUSTON LN 4 N HOUSTON LN 113 <br /> tta,115,11s <br /> LODI, CA 95240 LODI, CA 95240 <br /> Work phone 209-334-6803 209-334-6803 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009370 <br /> Facility name KUSTOM KURVES COLLISION REPAIR KUSTOM KURVES COLLISION REPAIR 3 <br /> Site address 4 N HOUSTON LN 4 N HOUSTON LN 103 <br /> City LODI LODI 104 <br /> Zip code 952402420 95240-2420 105 <br /> Facility phone 209-334-6803 (209) 334-6803 102 <br /> Facility mailing address 4 N HOUSTON LN 4 N HOUSTON LN 108a <br /> LODI, CA 95240 LODI, CA 95240 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name KUSTOM KURVES COLLISION REPAIR KUSTOM KURVES COLLISION REPAIR 140 <br /> Address 4 N HOUSTON LN 4 N HOUSTON LN 143 <br /> LODI, CA 95240 LODI, CA 95240 144, 145, 146 <br /> Contact phone Not Specified 209-334-6803 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 [ ] 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: (q lb β€’li <br /> Accountings VReviewed by: Date: Clerical: File [ ] Relabel file [ ] Create new file <br /> Acct billed Surcharge ver fled By: β€”β€” Date <br /> -- --------------- --- β€” - <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactiv d Inactivated <br /> 1920-HMBP-Common Materials PRO521023 JAMIE DE LA ROSA Inactive [ 1 <br /> 2220-SM HW GEN<5 TONSNR PRO513795 ARIS VELOSO Active [ ] [ 1 <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509370 HAZ MAT SJC OES Inactive [ ] [ 1 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531645 not assigned Inactive [ ] [ 1 <br /> -Ak' <br />