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SAN JOAQUTA OUNTY ENVIRONMENTAL HEALTH PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 4/28/2015 <br /> Submitted on: 4/23/2015 10:28:19AM CERS ID: 10183471 <br /> Submitted by: Matt Duaime Email: matt.duaime@stocktongov.com Facility ID in CERS: FA0010348 <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 East Side Rural Fire District CITY OF STOCKTON- Fire Department 111 <br /> Mailing address 4330 N Pershing Ave#61 425 N ELDORADO ST 113 <br /> STOCKTON, CA 95207 STOCKTON, CA 95202 114, 115, 116 <br /> Work phone 209-956-3516 (209) 937-8801 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010348 <br /> Facility name CITY OF STOCKTON FIRE STATION#14 CITY OF STOCKTON FIRE STATION#14 3 <br /> Site address 3019 MCNABB ST 3019 MCNABB ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95209 95209 105 <br /> Facility phone 209-937-8801 (209) 937-8801 102 <br /> Facility mailing address 3019 MCNABB ST 3019 MCNABB ST 108a <br /> STOCKTON, CA 95209 STOCKTON, CA 95209 108b,108c,108d <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, 146 <br /> Contact phone 209-937-8801 (209) 937-8801 141 <br /> Contact email 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ j LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST 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: � J-�) Date: f LI Ll <br /> Accounting: Reviewed by: V Date: °�14415 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ed By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials PRO539664 HAZA SAEED Active, Exempt I ] I ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510348 HAZ MAT SJC DES Inactive [ ] [ ] <br />