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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> E7 Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/13/2015 <br /> Submitted on: 3/25/2015 9:01:02AM CERS ID: 10186715 <br /> Submitted by: roberto Cuellar Email: element6mw@gmail.com Facility ID in CERS: FA0017944 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014740 <br /> Owner name ELEMENT 6 MOTOR WERKS INC ELEMENT 6 MOTOR WERKS INC. 111 <br /> Mailing address 923 MOFFAT BLVD 21001 SAN RAMON VALLEY BLVD 113 <br /> MANTECA, CA 95336 SAN RAMON, CA 94583 114, 115, 116 <br /> Work phone 209-679-9012 209-239-0639 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017944 <br /> Facility name Element 6 Motor Werks Inc ELEMENT 6 MOTOR WERKS, INC. 3 <br /> Site address 923 MOFFAT BLVD 923 MOFFAT BLVD 103 <br /> City MANTECA MANTECA 104 <br /> ZIP code 95366 95366 105 <br /> Facility phone 209-239-0639 2092390639 102 <br /> Facility mailing address 923 MOFFAT BLVD 923 MOFFAT BLVD 108a <br /> MANTECA, CA 95336 MANTECA, CA 95336 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name Element 6 Motor Werks Inc ELEMENT 6 MOTOR WERKS INC. 140 <br /> Address 923 MOFFAT BLVD 923 MOFFAT BLVD 143 <br /> MANTECA, CA 95336 MANTECA, CA 95366 144, 145, 146 <br /> Contact phone Not Specified 2092390639 141 <br /> Contact email hnstjhn8@yahoo.com element6mw@gmail.com 142 <br /> Mail invoices to Account <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: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: A Date: <br /> 7� — -- <br /> Accounting: Reviewed by: Date: q)2-4115 Clerical: - - <br /> 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 /> 1920-HMBP-Common Materials PRO526503 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0538587 ELENA MANZO Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532164 not assigned Inactive [ ] [ ] <br />