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SAN JOAQUIOUNTY ENVIRONMENTAL HEALTHPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 7/2/2014 <br />Submitted on: 1/15/2014 2:27:48PM <br />Submitted by: Gerardo Cela Email: cvccautobody@att.net <br />OWNER INFORMATION <br />Owner I D <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />OW0016463 <br />MANZO, GERARDO C <br />,1426 POPPY HILLS LN' <br />TRACY, CA 95377 <br />209-830-0561 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0020058 <br />Facility name <br />CENTRAL VALLEY COLLISION CENTER <br />Site address <br />24580 S MACARTHUR DR <br />City <br />TRACY <br />Zip code <br />95376 <br />Facility phone <br />209-830-0561 <br />Facility mailing address <br />24580 S MACARTHUR DR <br />TRACY, CA 95376 <br />BILLING INFORMATION <br />Contact name CENTRAL VALLEY COLLISION CENTER <br />Address 24580 S MACARTHUR DR <br />TRACY, CA 95376 <br />Contact phone 209-830-0561 <br />Contact email <br />Mail invoices to Facility <br />CERS ID: 10187495 <br />Facility ID in CERS: FA0020058 <br />Information after CIW processing CERS <br />(current submittal) field <br />Ceja Gerardo . 111 <br />24580 S MacArthur, Dr. 113 <br />TRACY, CA 95376 114, 115, 116 <br />2098300561 112 <br />CENTRAL VALLEY COLLISION CENTER <br />3 <br />24580 S MACARTHUR DR <br />103 <br />TRACY <br />104 <br />95376 <br />105 <br />(209) 830-0561 <br />102 <br />24580 S MACARTHUR DR <br />108a <br />TRACY, CA 95376 108b, 108c, 108d <br />Beatriz Ceja 140 <br />24580 S MACARTHUR DR 143 <br />TRACY, CA 95376 144, 145, 146 <br />2098300561 141 <br />cvccautobody@att.net, 142 <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: Y full calendar year [ ] prorate this calendar year [ ] next cale�ndar°year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: � / `1'yDate: 1 <br />Accounting: Reviewed by:_ Date:i�q 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 />2220 - SM HW GEN <5 TONSIYR PR0531141 THUY TRAN Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE F PRO534377 not assigned Inactive [ ] [ ] <br />(ihn!'r 25q 1r4 I /� 6k�� <br />