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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/27/2014 <br /> Submitted on: 1/31/2013 12:45:51PM CERS ID: 10184595 <br /> Submitted by: JILL MCCONNELL Email: brooksbdyshp@aol.com Facility ID in CERS: FA0014300 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0011354 <br /> Owner name BROOKS AUTO BODY DAN PETKER/TIM HARRIS 111 <br /> Mailing address 941 MOFFAT BLVD 941 MOFFAT BLVD 113 <br /> MANTECA, CA 95336 MANTECA, CA 95336 114, 115, 116 <br /> Work phone 209-823-4452 (209) 823-4452 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014300 <br /> Facility name BROOKS AUTO BODY BROOKS AUTO BODY 3 <br /> Site address 941 MOFFAT BLVD 941 MOFFAT BLVD 103 <br /> City MANTECA MANTECA 104 <br /> Zip code 95336 95336 105 <br /> Facility phone 209-823-4452 (209) 823-4452 0 102 <br /> Facility mailing address 941 MOFFAT BLVD 941 MOFFAT BLVD 108a <br /> MANTECA, CA 95336 MANTECA, CA 95336 108b,108c,load <br /> BILLING INFORMATION <br /> Contact name BROOKS AUTO BODY JILL MCCONNELL 140 <br /> Address 941 MOFFAT BLVD 941 MOFFAT BLVD 143 <br /> MANTECA, CA 95336 MANTECA, CA 95336 144, 145, 146 <br /> Contact phone Not Specified (209)823-4452 141 <br /> Contact email 142 <br /> Mail invoices to Owner-/ <br /> Program record [ ] HMBP [ ] SQG HW [ j 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 this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: 12(l rl- Date: Z u I <br /> Accounting: Reviewed by _ Date: Clerical: File [ ] Relabel file [ ] Create new file <br /> [ ] A Iled [ ] Surc verfied By: 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 PR0521261 MICHAEL PARISSI Active [ ] [ ] <br /> 2220-SM HW GEN c5 TONS/YR PR0523364 ELENA MANZO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0519173 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532541 not assigned Inactive [ ] [ ] <br />