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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/6/2018 <br />Submitted on: 12/15/2017 11:02:47AM CERS ID: 10752103 <br />Submitted by: PETE PARAFIN Email: FLUIDMFG@AOL.COM Facility ID in CERS: incorrect <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: 1 <br />OW0023160 <br />CARY & LYNETTE PARAFIN <br />FLUIDMFG@AOL.COM <br />LODI, CA 95240 <br />209-772-3085 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0024569 <br />Facility name <br />FLUID MANUFACTURING <br />Site address <br />1001 Black Diamond Way Ste C <br />City <br />Lodi <br />ZIP code <br />95240 <br />Facility phone <br />209-334-6144 <br />Facility mailing address 1001 BLACK DIAMOND WAY, SUITE C <br />LODI, CA 95240 <br />BILLING INFORMATION <br />Contact name <br />Address <br />Contact phone <br />Contact email <br />Mail invoices to <br />PETE PARAFIN <br />1001 BLACK DIAMOND WAY, SUITE C <br />LODI, CA 95240 <br />209-772-3085 <br />FLUIDMFG@AOL.COM <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />CARY & LYNETTE PARAFIN 111 <br />FLUIDMFG@AOL.COM 113 <br />LODI, CA 95240 114, 115, 116 <br />2097723085 112 <br />FLUID MANUFACTURING 3 <br />1001 Black Diamond Way Ste C 103 <br />Lodi 104 <br />95240 105 <br />209-334-6144 102 <br />1001 BLACK DIAMOND WAY, SUITE C 108a <br />LODI, CA 95240 108b, 108c, 108d <br />PETE PARAFIN 140 <br />1001 BLACK DIAMOND WAY, SUITE C 143 <br />LODI, CA 95240 144, 145, 146 <br />2097723085 141 <br />FLUIDMFG@AOL.COM 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST <br />New PR#: _ <br />New PE: _ <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />L. <br />Processed through CERS Integration Wizard by: r� Date: r'�-� <br />Accounting: Reviewed by: i4 Date: 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 Employee name Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location 3 chem units PR0542864 JAMIE LIMA Active I I I I <br />("-tl 30(0L(_�_> -2--.) . <br />