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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/24/2017 <br />Submitted on: 4/19/2017 2:29:47PM <br />Submitted by: Paul Daveluy Email: pdaveluy@sjgov.org <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner : n 9 <br />OW0009441 <br />DEPT OF AGING <br />PO BOX 201056 <br />STOCKTON, CA 95202 <br />209-851-8370 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0013563 <br />Facility name <br />SJC COMMODITY PROGRAM <br />Site address <br />2736 TEEPEE DR C <br />City <br />STOCKTON <br />ZIP code <br />95205 <br />Facility phone <br />209-468-3679 <br />Facility mailing address <br />PO BOX 201056 <br />STEPHANIE RAMIREZ <br />STOCKTON, CA 95201 <br />BILLING INFORMATION <br />PR0533347 <br />Contact name <br />SJC COMMODITY PROGRAM <br />Address <br />PO BOX 201056 <br />STOCKTON, CA 95201 <br />Contact phone <br />209-468-3679 <br />Contact email <br />Mail invoices to <br />Account <br />CERS ID: 10184411 <br />Facility ID in CERS: FA0013563 <br />Information after CIW processing CERS <br />(current submittal) field <br />SAN JOAQUIN CO DEPT OF AGING 111 <br />PO BOX 201056 113 <br />STOCKTON, CA 95201 114, 115, 116 <br />209-468-3679 112 <br />SJC COMMODITY PROGRAM 3 <br />2736 TEEPEE DR #C 103 <br />STOCKTON 104 <br />95205 105 <br />(209) 468-3679 102 <br />PO BOX 201056 108a <br />STOCKTON, CA 95201 108b, 108c, 108d <br />SJC COMMODITY PROGRAM 140 <br />PO BOX 201056 143 <br />STOCKTON, CA 95201 144, 145, 146 <br />209-468-3679 141 <br />142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG 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: ove-n � Date: -� 17 <br />Accounting: Reviewed by: � Date: 51z1/ Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1632 - EXEMPT FOOD <br />PRO517717 <br />JEFFREY WONG <br />Active [ ] [ ] <br />1920 - HMBP-Common Materials 1 chem units <br />PRO521057 <br />ROBERT LOPEZ <br />Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PR0519211 <br />STEPHANIE RAMIREZ <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0533347 <br />not assigned <br />Inactive <br />