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SAN JOAQUP. COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 2/24/2015 <br />Submitted on: 1/15/2015 8:58:18AM <br />Submitted by: Carlos Martinez -Diaz Email: cmartinez@tomduffy.com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />OW0008916 <br />BR FUNSTEN & CO <br />105 E INDUSTRIAL PARK DR <br />MANTECA, CA 95337 <br />415-641-1200 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0010916 <br />Facility name <br />BR FUNSTEN & CO <br />Site address <br />105 E INDUSTRIAL PARK DR <br />City <br />MANTECA <br />ZIP code <br />95337-6103 <br />Facility phone <br />209-825-5375 <br />Facility mailing address 105 E INDUSTRIAL PARK DR <br />MANTECA, CA 95337 <br />BILLING INFORMATION <br />Contact name BR FUNSTEN & CO <br />Address 105 E INDUSTRIAL PARK DR <br />MANTECA, CA 95337 <br />Contact phone 209-824-7131 <br />Contact email <br />i1- f <br />Mail invoices to ,,Gam d <br />CERS ID: 10183933 <br />Facility ID in CERS: FA0010916 <br />Information after CIW processing <br />(current submittal) <br />BR FUNSTEN & CO <br />825 VAN NESS <br />SAN FRANCISCO, CA 94109-7837 <br />(888)261-2871 <br />BR FUNSTEN & CO <br />105 E INDUSTRIAL PARK DR <br />MANTECA <br />95337-6103 <br />(209) 825-5375 0 <br />105 INDUSTRIAL PARK Drive <br />MANTECA, CA 95337 <br />BR FUNSTEN & CO <br />105 E INDUSTRIAL PARK -DR <br />MANTECA, CA 95337 <br />(707) 863-8300 <br />Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST <br />New PR#: <br />New PE: <br />Assigned to: <br />CERS <br />field <br />111 <br />113 <br />114, 115, 116 <br />112 <br />3 <br />103 <br />104 <br />105 <br />102 <br />108a <br />108b, 108c, 108d <br />140 <br />143 <br />144, 145, 146 <br />141 <br />142 <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: '�L��O Date: <br />Accounting: Reviewed by: Id— Date: 3 6 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 />1921 - HMBP-Regular-Primary Location PR0520547 MICHAEL PARISSI Active [ ] [ ] <br />4740 - WASTE TIRE SITE - EXEMPT PRO535215 BENJAMIN ESCOTTO Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510916 HAZ MAT SJC OES Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0534371 not assigned Inactive [ ] [ ] <br />