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SAN JOAQUIN .,OUNTY ENVIRONMENTAL HEALTh oEPARTMENT &r <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/11/2014 <br /> Submitted on: 1/16/2014 4:09:01PM CERS ID: 10472077 <br /> Submitted by: Kelly Reilly Email: kellyscarwash@yahoo.com Facility ID in CERS: <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0008526 <br /> Owner name KELLY REILLY KELLY'S EXPRESS CARWASH LLC 111 <br /> Mailing address 5942 ST ANDREWS DR 5942 SAINT ANDREWS DRIVE 113 <br /> STOCKTON, CA 95219 STOCKTON, CA 95219 114, 115, 116 <br /> Work phone 209-670-7750 209-475-9314 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022097 <br /> Facility name Kelly's Express Carwash Kelly's Express Carwash 3 <br /> Site address 5112 Scotts Creek Dr 5112 Scotts Creek Dr 103 <br /> City Stockton Stockton 104 <br /> Zip code 95219 95219 105 <br /> Facility phone 209-475-9314 209-475-9314 102 <br /> Facility mailing address 5942 SAINT ANDREWS DRIVE 5942 SAINT ANDREWS DRIVE 108a <br /> 5942 ST ANDREWS DR <br /> STOCKTON, CA 95219 STOCKTON, CA 95219 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name Kelly Reilly Kelly Reilly 140 <br /> Address 5942 St. Andrews Drive 5942 St. Andrews Drive 143 <br /> Stockton, CA 95219 Stockton, CA 95219 144, 145, 146 <br /> Contact phone 209-475-9314 209-475-9314 141 <br /> Contact email kellyscarwash@yahoo.com kellyscarwash@yahoo.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG 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: Date: <br /> Accounting: Reviewed by: _ec —Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> west-b+lled 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 PR0538237 JAMIE DE LA ROSA Active I I I I <br />