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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/21/2014 <br /> Submitted on: 5/2/2014 1:56:12PM CERS ID: 10181435 <br /> Submitted by: Harvinder Singh Email: bigts1@aol.com Facility ID in CERS: FA0003803 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0005264 <br /> Owner name SINGH, HARVINDER PAL& NITA SINGH, HARVINDER PAL& NITA 111 <br /> Mailing address 8692 CANEPA RD 8692 CANEPA RD 113 <br /> STOCKTON, CA 952129425 MORADA, CA 95212-9425 114, 115,116 <br /> Work phone 209-333-0305 209-931-5759 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003803 <br /> Facility name KETTLEMAN CHEVRON KETTLEMAN CHEVRON 3 <br /> Site address 601 E KETTLEMAN LN 601 E KETTLEMAN LN 103 <br /> City LODI LODI 104 <br /> Zip code 95240 95240 105 <br /> Facility phone 209-333-0305 (209) 333-0305 102 <br /> Facility mailing address 601 E KETTLEMAN LN 601 E KETTLEMAN LN 108a <br /> LODI, CA 95240 LODI, CA 95240 108b,108c,load <br /> BILLING INFORMATION <br /> Contact name KETTLEMAN CHEVRON KETTLEMAN CHEVRON 140 <br /> Address 601 E KETTLEMAN LN 601 E KETTLEMAN LN 143 <br /> LODI, CA 95240 LOD], CA 95240 144, 145, 146 <br /> Contact phone 209-368-0715 209-333-0305 141 <br /> Contact email 142 <br /> Mail invoices to Facility\ <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: k4� Date: (o '}I . iq <br /> �77]-- -- ------------ - <br /> Accounting: Reviewed by: f& Date: Clerical: File [ ] Relabel file ( ] Create new file <br /> [ ] Ac I led [ ] Surc a verifie By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1615-RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PREP; PRO505163 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0520964 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0518102 ARIS VELOSO Active [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PRO508268 Fatina Zareef Inactive [ ] [ ] <br /> 2361 -UST FACILITY PR0231348 ARIS VELOSO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507474 Fatina Zareef Inactive ( ] [ ] <br />