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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 7/2/2014 <br />Submitted on: 2/17/2014 1:30:15PM CERS ID: 10187555 <br />Submitted by: Karen Buettner Email: karen@deltamarinesales.com Facility ID in CERS: FA0020330 <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 />OW0016691 <br />DELTA MARINE SERVICES INC <br />4453 YACHT HARBOR DR <br />STOCKTON, CA 95203 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0020330 <br />Facility name <br />DELTA MARINE SERVICES INC <br />Site address <br />401 N SAN JOSE ST <br />City <br />STOCKTON <br />Zip code <br />95203 <br />Facility phone <br />209-481-1411 <br />Facility mailing address <br />401 N SAN JOSE ST <br />STOCKTON, CA 95203 <br />BILLING INFORMATION <br />Contact name DELTA MARINE SERVICES INC <br />Address 401 N SAN JOSE ST <br />STOCKTON, CA 95203 <br />Contact phone 209-481-1411 <br />Contact email <br />Mail invoices to Facility <br />Information after CIW processing CERS <br />(current submittal) field <br />1� P R I Nt c�kveE5 N C� <br />TONY -FASO-- 111 <br />4453 YACHT HARBOR DR 113 <br />STOCKTON, CA 95203 114, 115, 116 <br />209-463-0384 112 <br />DELTA MARINE SERVICES INC <br />3 <br />401 N SAN JOSE ST <br />103 <br />STOCKTON <br />104 <br />95203 <br />105 <br />(209) 481-1411 <br />102 <br />401 N SAN JOSE ST <br />108a <br />STOCKTON, CA 95203 108b, 108c, 108d <br />TONY FASO 140 <br />401 N SAN JOSE ST 143 <br />STOCKTON, CA 95203 144, 145, 146 <br />209-463-0384 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: Date: <br />----------------------- ------------------------ <br />Accounting: Reviewed by: ) Date: D o2 Clerical: V] File [ ] Relabel file [ ] Create new file <br />[, ] t billed [ ] Surc afg6 verified _ —By:— — _ Date_ <br />-------f� — — — — �------ <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated Inactivated <br />2220 - SM HW GEN <5 TONSNR PR0535168 JEFFREY WONG Active [ ] [ ] <br />2831 -AST FAC >/= 1,320 - <10 K GAL CUMULATIVE PRO535169 JEFFREY WONG Active, Exempt (] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE F PR0535170 not assigned Inactive [ ] [ ] <br />