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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 11/30/2015 Submitted on: 11/24/2015 3:24:39PM CERS ID: 10187851 Submitted by: Debbie Livermore Email: debbie.livermore@stocktongov.com Facility ID in CERS: FA0021386 FA0021386 Information prior to CIW processing Information after CIW processing CERS OWNER INFORMATION (current EC database) (current submittal) field 95219 Number of Facilities for this Owner : 70 209-937-8246 Facility mailing address Owner ID OW0008643 STOCKTON, CA 95206 BILLING INFORMATION Owner name CITY OF STOCKTON CITY OF STOCKTON 111 Mailing address 425 N. ELDORADO STREET 425 N. ELDORADO 113 209-937-8700 STOCKTON, CA 95202 STOCKTON, CA 95202 114, 115, 116 Work phone 209-937-8341 209-937-8341 i 112 FACILITY FILE INFORMATION Facility ID FA0021386 Facility name STOCKTON MUD WELLS-BUCKLEY COVE Site address W MARCH LN City STOCKTON ZIP code 95219 Facility phone 209-937-8246 Facility mailing address 2500 NAVY DR STOCKTON, CA 95206 BILLING INFORMATION Contact name STOCKTON MUD WELLS-BUCKLEY COVE Address 2500 NAVY DR STOCKTON, CA 95206 Contact phone 209-937-8700 Contact email Mail invoices to Account i Buckley Cove 3 3910 W March Ln 103 STOCKTON 104 95219 105 (209) 937-8700 102 2500 NAVY DR 108a STOCKTON, CA 95206 108b, 108c, 1084 CITY OF STOCKTON - MUD 140 2500 NAVY DR 143 STOCKTON, CA 95206 144, 145, 146 209-937-8700 141 142 Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: i created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year exempt from billing Processed through CERS Integration Wizard by: Date: I'� �ID I --------------------- ----- ----- Accounting: Reviewed by: Lb Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] Acct billed [ ] Surcharge verified By: Date: —---------- — --------------- ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 1926 - HMBP-Unstaffed Network Location PR0537259 HAZA SAEED Active [ ] [ ] -AST QAC >/= 1,320 - <10 K GAL CUMULATIVE PR0528525 FATINAH ZAREEF Inactive [ ] ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0533313 not assigned Inactive l [ ] [ ]