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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 4/2/2015 <br /> Submitted on: 1/23/2015 8:26:OOAM CERS ID: 10187199 <br /> Submitted by: Kareemah Montano Email: kareemahq@live.com Facility ID in CERS: FA0019310 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0015852 <br /> Owner name MONTANO, KAREEMAH MONTANO, KAREEMAH 111 <br /> Mailing address 1768 COUNTRY CLUB BLVD 2011 claycomb way 113 <br /> STOCKTON, CA 95204 STOCKTON, CA 95206 114, 115, 116 <br /> Work phone 209-639-4803 209-6394803 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019310 <br /> Facility name FAIRWAY AUTOMOTIVE REPAIR INC FAIRWAY AUTOMOTIVE REPAIR INC 3 <br /> Site address 2735 TEEPEE DR 2735 TEEPEE DR STE 1A 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone 209-942-2915 (209) 942-2915 102 <br /> Facility mailing address 2735 TEEPEE DR STE 1A 2735 TEEPEE DR STE 1A 108a <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name FAIRWAY AUTOMOTIVE REPAIR INC FAIRWAY AUTOMOTIVE REPAIR INC 140 <br /> Address 1768 country club blvd 1// 2011 claycomb way 143 <br /> STOCKTON, CA 95204 STOCKTON, CA 95206 144, 145, 146 <br /> Contact phone 209-639-4803 209-639-4803 141 <br /> Contact email fairwayautorepair@hotmail.comfairwayautorepair@hotmail.com <br /> / fairwayautorepair@hotmail.com 142 <br /> Mail invoices to I/ <br /> Program record [ ] HMBP [ ] SQG HW [ ] 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: 05'1 Date: (� <br /> - -- — —— — — —————— ----------- _ . .- - <br /> Accounting: Reviewed by: '144' Date: S 8' 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 Inactivated <br /> 1920-HMBP-Common Materials PR0528747 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0535352 JEFFREY WONG Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533200 not assigned Inactive [ ] [ ] <br />