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SAN JOAQUi. ;OUNTY ENVIRONMENTAL HEALD. DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/6/2015 <br />Submitted on: 3/13/2015 11:11:57AM <br />Submitted by: Scott Bundy Email: sbundy@kellymoore.com <br />CERS ID: 10481713 <br />Facility ID in CERS: FA0022747 <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Owner ID <br />OW0020542 <br />City <br />Stockton <br />Owner name <br />Kelly -Moore Paints <br />Kelly -Moore Paints <br />111 <br />Mailing address <br />987 Commercial St <br />987 Commercial St. <br />113 <br />209-465-3473 <br />San Carlos, CA 94070 <br />San Carlos, CA 94070 <br />114, 115, 116 <br />Work phone <br />800-874-4436 <br />800-874-4436 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0022747 <br />Facility name <br />Kelly -Moore Paints <br />Kelly -Moore Paints <br />3 <br />Site address <br />2225 MONTE DIABLO AVE <br />2225 Monte Diablo Ave <br />103 <br />City <br />Stockton <br />Stockton <br />104 <br />ZIP code <br />95203 <br />95203 <br />105 <br />Facility phone <br />209-465-3473 <br />209-465-3473 <br />102 <br />Facility mailing address <br />2225 Monte Diablo Ave. <br />2225 Monte Diablo Ave. <br />108a <br />Stockton, CA 95203 <br />Stockton, CA 95203 <br />108b,108c, 108d <br />BILLING INFORMATION <br />Contact name KELLY MOORE PAINTS <br />Address 987 Commercial St. <br />San Carlos, CA 94070 <br />Contact phone 650-610-4179 <br />Contact email ptornincasa@kellymoore.com <br />Mail invoices to Account <br />Pat Tornincasa <br />987 Commercial St. <br />San Carlos, CA 94070 <br />650-610-4179 <br />ptornincasa@kellymoore.com <br />Program record [ J HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />New PE: <br />Assigned to: <br />140 <br />143 <br />144, 145, 146 <br />141 <br />142 <br />Please bill: [ ] full calendar year [ ] prorate this calendar year (] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: <br />Accounting: Reviewed by: L6 Date: 41 1 / � Clerical: 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 Ina iv ed <br />1921 - HMBP-Regular-Primary Location PR0539762 ROBERT LOPEZ Active I I <br />