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SAN JOAQUIr-c:OUNTY ENVIRONMENTAL HEALTh-6EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/212014 <br /> Submitted on: 211112014 9:50:33AM CERS ID: 10187443 <br /> Submitted by: Paula Bamer Email: paula.bamer@iusupply.com Facility ID in CERS: FA0019938 <br /> Information prior to ClW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0016361 <br /> Owner name INDEPENDENT UTILITY SUPPLY INDEPENDENT ELECTRIC SUPPLY 111 <br /> Mailing address 200 E LARCH RD 1370 BAYPORT AVE 113 <br /> TRACY, CA 95304 SAN CARLOS, CA 94070 114. 115, 116 <br /> Work phone 650-594-9440 650-594-9440 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019938 <br /> Facility name INDEPENDENT UTILITY SUPPLY INDEPENDENT UTILITY SUPPLY 3 <br /> Site address 200 E LARCH RD 200 E LARCH RD 103 <br /> City TRACY TRACY 104 <br /> Zip code 95304 95304 105 <br /> Facility phone 209-832-2038 (209) 832-2038 0 102 <br /> Facility mailing address 200 E LARCH RD 200 E LARCH RD 108a <br /> TRACY, CA 95304 TRACY, CA 95304 108b, 108c,load <br /> BILLING INFORMATION <br /> Contact name INDEPENDENT UTILITY SUPPLY INDEPENDENT UTILITY SUPPLY 140 <br /> Address 200 E LARCH RD 200 E LARCH RD 143 <br /> TRACY, CA 95304 TRACY, CA 95304 144, 145, 146 <br /> Contact phone Not Specified 209-832-2038 141 <br /> Contact email theresa.mendez@iusupply.com 142 <br /> Mail invoices to Owner <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: [ J full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by: Date: 8 D Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> d 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 PR0530782 MICHAEL PARISSI Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PRO532350 not assigned Inactive [ ] [ ] <br />