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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 3!412015 <br /> Submitted on: 1114/2015 9:56:23AM CERS ID: 10185125 <br /> Submitted by: Staci Bevell Email: staci@trucklubricationco.com Facility ID in CERS: FA0016213 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013109 <br /> Owner name ROBERT BUMSTEAD ROBERT BUMSTEAD 111 <br /> Mailing address 143 S PIXLFY ST 143 S PIXLEY ST 113 <br /> ORANGE, CA 92868 ORANGE, CA 92868 114, 115, 116 <br /> Work phone 714-997-7730 (714) 997-7730 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016213 <br /> Facility name TRUCK LUBRICATION COMPANY TRUCK LUBRICATION COMPANY 3 <br /> Site address 523 W LARCH STE 523 W LARCH RD STE 103 <br /> City TRACY TRACY 104 <br /> ZIP code 95304 95304 105 <br /> Facility phone 209-833-3409 (209) 833-3409 0 102 <br /> Facility mailing address 523 W LARCH RD STE A 523 W LARCH RD STE A 108a <br /> TRACY, CA 95304 TRACY, CA 95304 108h, 108c,108d <br /> BILLING INFORMATION <br /> Contact name TRUCK LUBRICATION COMPANY TRUCK LUBRICATION COMPANY 140 <br /> Address 143 S PIXLEY ST 143 S PIXLEY ST 143 <br /> ORANGE, CA 92868 ORANGE, CA 92868 144, 145, 146 <br /> Contact phone 714-997-7730 (714) 997-7730 141 <br /> Contact email staci@trucklubricationco.com staci@trucklubricationco.cam 142 <br /> Mail invoices to Account <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 /> Accounting: Reviewed by: Date: (a 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 /> 1921 -HMBP-Regular-Primary Location PR0524122 MICHAEL PARISSI Active [ ] [ <br /> 2221 -USED OIL ONLY-<5 TONSIYR PR0535902 THUY TRAN Active [ ] [ <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATIVE PR0535903 THUY TRAN Active [ J [ I <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533907 not assigned Inactive [ [ ] <br />