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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 <br /> Changes to EnvisionConnect by CERS Inte 0tion Wizard Date run: 7/17/2014 <br /> Submitted on: 2/28/2013 2:56:17PM m na cqpy CERS ID: 10417681 <br /> Submitted by: Rebecca Very Email: beckyvery@elesco.us acility ID in CERS: FA0003660 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) !� (c rent submittal) field <br /> Owner ID OW0009014 r aA^�- l�'�'�`'0�--- <br /> Owner name VERY, BRIAN D Brian Very- Rebecca Very 111 <br /> Mailing address 170 MCCORMICK AVE 24031 Dory Drive ' 113 <br /> COSTA MESA, CA 926263307 Laguna Niguel, CA 92677 114, 115, 116 <br /> Work phone 209-464-2288 949-218-3502 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003660 <br /> Facility name ELESCO ELESCO 3 <br /> Site address 2735 N TEEPEE DR A 2735 Teepee Or Ste A 103 <br /> City STOCKTON Stockton 104 <br /> Zip code 95205 95205 105 <br /> Facility phone 209-465-3500• 209-464-2288 102 <br /> Facility mailing address 170 MCCORMICK AVE 170 McCormick Avenue 108a <br /> COSTA MESA, CA 92626-3307 Costa Mesa, CA 92626 1081b,108c,10W <br /> BILLING INFORMATION <br /> Contact name ELESCO Rebecca Very 140 <br /> Address 170 MCCORMICK AVE 170 McCormick Avenue 143 <br /> COSTA MESA, CA 92626-3307 Costa Mesa, CA 92626 144,145,146 <br /> Contact phone Not Specified 714-673-6600 141 <br /> Contact email beckyvery@elesco.us 142 <br /> Mail invoices to Facility <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: Date: <br /> -------------- <br /> — — ---------------------- <br /> Accountin Reviewed b :�—Date: O Clerical• A File 14- label file [ ] Create new file <br /> Acct ' ed [ ] Surchar nfi d By: Date: <br /> _ [ ] _ _ <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 PRO538681 JAMIE DE LA ROSA Active [ ] [ 1 <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0232567 LETITIA BRIGGS Inactive [ ] [ ] <br />