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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Submitted on: 10/13/2014 1:50:41PM Date run: 11/612014 <br /> Submitted by: Kevin Myose Email: kmyose@sjgov.crg CERS ID: 10588471 <br /> Facility ID in CERS: FA0022530 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0020068 <br /> Owner name San Joaquin County San Joaquin County <br /> Mailing address 444 S. Wilson Way 444 S. Wilson Way <br /> Stockton, CA 95205 113 <br /> Stockton, CA 95205 114, 115, 112 <br /> Work phone 209-468-3099 209-468-3099 <br /> 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022530 <br /> Facility name Fleet Services - Hospital/Park South Fleet Services - Hospital/Park South 3 <br /> Site address 500 W Hospital Rd 500 W Hospital Rd 103 <br /> City French Camp French Camp 104 <br /> Zip code 95231 95231 105 <br /> Facility phone 209-468-3099 209-468-3099 102 <br /> Facility mailing address 444 S. Wilson Way 444 S. Wilson Way 108a <br /> Stockton, CA 95205 Stockton, CA 95205 108b, 108c,10E <br /> BILLING INFORMATION <br /> Contact name Robyn Gilford David B. Myers 140 <br /> Address 444 S. Wilson Way 444 S. Wilson Way 143 <br /> Stockton, CA 95205 Stockton, CA 95205 144, 145, 14( <br /> Contact phone 209-468-3099 209-468-9745 141 <br /> Contact email rgilford@sjgov.org dbmyers@sjgov.org 142 <br /> Mail invoices to Faeikty 4,/ <br /> Program record [ ] HMBP [ j 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 [ J prorate this calendar year j ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: LT Date: <br /> Accounting: Reviewed by: Date: 1) Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> _[ ]] Acrt.I3ilied [ ] Surcha eri ted <br /> � 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 PR0539419 MICHAEL PARISSI Active [ ] [ <br /> 2831 -AST FAC >1= 1,320-<10 K GAL CUMULATIVE PR0539420 T-iUY TRAN Active [ ] [ <br />