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SAN JOAQUIN , .AUNTY ENVIRONMENTAL HEALTH U.PARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 6/24/2015 <br />Submitted on: 6/15/2015 8:32:17AM <br />Submitted by: Danielle Kurek Email: danielle.kurek@amgh.us <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 />OW0016518 <br />REACH AIR MEDICAL SERVICES <br />N AVIATION SUITE 201 BLVD <br />SANTA ROSA, CA 95403 <br />707-324-2499 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0020117 <br />Facility name <br />REACH AIR MEDICAL SERVICES <br />Site address <br />6364 LINDBERGH ST <br />City <br />STOCKTON <br />ZIP code <br />95206 <br />Facility phone <br />707-324-2499 <br />Facility mailing address N AVIATION SUITE 201 BLVD <br />SANTA ROSA, CA 95403 <br />BILLING INFORMATION <br />Contact name REACH AIR MEDICAL SERVICES <br />Address N AVIATION SUITE 201 BLVD <br />SANTA ROSA, CA 95403 <br />Contact phone Not Specified <br />Contact email <br />Mail invoices to Owner <br />CERS ID: 10582006 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Reach Air Medical Services, LLC 111 <br />451 Aviation Blvd 113 <br />Santa Rosa, CA 95403 114, 115, 116 <br />707-303-3652 112 <br />Reach 02 3 <br />6364 Lindbergh St 103 <br />Stockton 104 <br />95206 105 <br />707-303-3652 102 <br />6364 Lindbergh St 108a <br />Stockton, CA 95206 108b, 108c, 10sd <br />Danielle Kurek 140 <br />209 State Highway 121 Bypass, Suite 21 143 <br />Lewisville, TX 75067 144, 145, 146 <br />972-829-8421 141 <br />danielle.kurek@amgh.us 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />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: 5 <br />Accounting: Reviewed by: Date: I j 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 PR0531231 not assigned Inactive ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0533253 not assigned Inactive [ ] [ ] <br />