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SAN JOAQU"WCOUNTY ENVIRONMENTAL HEALTh•wEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 4/6/2015 <br /> Submitted on: 3/4/2015 12:44:54PM CERS ID: 10187773 <br /> Submitted by: angela morrone Email: cal_plant@kingsdown.com Facility ID in CERS: FA0021146 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0017421 <br /> Owner name KINGSDOWN INC KINGSDOWN INC 111 <br /> Mailing address 1631 INDUSTRIAL DR P.O. Box 388 113 <br /> STOCKTON, CA 95206 Mebane, INC 27302 114, 115,116 <br /> Work phone 209-234-1436 209-234-1436 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021146 <br /> Facility name KINGSDOWN INC KINGSDOWN INC 3 <br /> Site address 1631 INDUSTRIAL DR 1631 INDUSTRIAL DR 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95206 95206 105 <br /> Facility phone 209-234-1436 (209) 234-1436 102 <br /> Facility mailing address 1631 INDUSTRIAL DR P.O. Box 388 108a <br /> STOCKTON, CA 95206 Mebane, CA 95240 108b,108c,toad <br /> BILLING INFORMATION <br /> Contact name KINGSDOWN INC / KINGSDOWN INC 140 <br /> Address PO BOX 388 ✓ P.O. Box 388 143 <br /> MEBANE, NC 27302 Mebane, NC 27302 144, 145,146 <br /> Contact phone 209-234-1436 209-234-1436 141 <br /> Contact email 142 <br /> Mail invoices to Account <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: A Date: Li' (0-t <br /> ------g' -----y-- -- <br /> Accountin Reviewed b : Date: S/��I� 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 Inactivated <br /> 1921 -HMBP-Regular-Primary Location PR0536814 ROBERT LOPEZ Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE R PR0536826 not assigned Inactive [ ] [ ] <br />