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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run:4/10/2015 <br /> Submitted on: 4/8/2015 2:24:13PM CERS ID: 10621813 <br /> Submitted by: Beverly Sandoval Email: solidsmanagement@aol.com Facility ID in CERS: incorrect <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0011318 <br /> Owner name KARL NEEDHAM ENTERPRISES Karl Needham 111 <br /> Mailing address 4901 E MARIPOSA RD 4901A E Mariposa Rd 113 <br /> STOCKTON, CA 95215 Stockton, CA 95215 114, 115,116 <br /> Work phone 209-304-0820 209-304-0820 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014264 <br /> Facility name KARL NEEDHAM ENTERPRISES Karl Needham Enterprises, Inc. 3 <br /> Site address 4901 E MARIPOSA 4901A E Mariposa Rd 103 <br /> City STOCKTON Stockton 104 <br /> ZIP code 95205 95215 105 <br /> Facility phone 209-462-9600 209-462-9600 102 <br /> Facility mailing address 4901 E MARIPOSA RD 4901A E Mariposa Rd 108a <br /> STOCKTON, CA 95215 Stockton, CA 95215 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name KARL NEEDHAM ENTERPRISES Beverly Sandoval 140 <br /> Address 4901 E MARIPOSA RD 4901A E Mariposa Rd 143 <br /> STOCKTON, CA 95215 Stockton, CA 95215 144, 145, 146 <br /> Contact phone Not Specified 209-462-9600 141 <br /> Contact email solidsmanagement@aol.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created ( ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate <br /> `this <br /> 1calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: _ Li•1�•t 1 <br /> — ---- -----Y— ------ ---------- --- — <br /> Accounting: Reviewed by: � Date: q�/&4/' Clerical:X File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> -------------------------------- <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 PRO520353 HAZ MAT SJC OES Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO539908 STACY RIVERA Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524435 AMANDA BOERTIEN Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0519063 HAZ MAT SJC DES Inactive [ ] [ ] <br />