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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 12/1/2014 <br /> Submitted on: 11/18/2014 7:35:57AM CERS ID: 10182905 <br /> Submitted by: Matt Duaime Email: matt.duaime@stocktongov.com Facility ID in CERS: FA0009788 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001176 <br /> Owner name CITY OF STOCKTON FIRE DEPARTMENT CITY OF STOCKTON FIRE DEPARTMENT 111 <br /> Mailing address 425 N EL DORADO ST 425 N ELDORADO ST 113 <br /> STOCKTON, CA 95202 STOCKTON, CA 95202 114, 115, 11e <br /> Work phone 209-937-8801 (209) 937-8801 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009788 <br /> Facility name CITY OF STOCKTON FIRE STATION#5 CITY OF STOCKTON FIRE STATION#5 3 <br /> Site address 3499 MANTHEY RD 3499 MANTHEY RD 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95206 95206 105 <br /> Facility phone 209-937-8801 (209) 937-8801 102 <br /> Facility mailing address 3499 MANTHEY RD 3499 MANTHEY RD 108a <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 108b,108c,106 <br /> BILLING INFORMATION <br /> Contact name CITY OF STOCKTON FIRE DEPARTMENT CITY OF STOCKTON FIRE DEPARTMENT 140 <br /> Address 425 N ELDORADO ST 425 N ELDORADO ST 143 <br /> STOCKTON, CA 95202 STOCKTON, CA 95202 144, 145, 14f <br /> Contact phone 209-937-8801 (209)937-8801 141 <br /> Contact email 142 <br /> Mail invoices to Account <br /> Program record [)q HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PRM 3W -A.- <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: kit i <br /> Assigned to: r t <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: &.11 Date: Z [ ,^i <br /> Accounting: Reviewed by: Date: Clerical: [ ) File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified g <br /> - -- _ -- y: 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 PRO539640 ROBERT LOPEZ Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0509788 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0528826 FATINAH ZAREEF Inactive [ ] [ ] <br /> —Ih�s rcPor•Y fun piY�cr cl�ay5es unr� wade <br />