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--------------- <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/27/2 4 <br /> Submitted on: 4/4/2014 9:45:54AM CERS I 184005 <br /> Submitted by: LISA COUSSONS Email: lisa@brockconstruction.com Facility ID in CERS: FA0010980 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> \` <br /> Owner ID OW0008980 "'t'o o ryw `� <br /> Owner name GARY& LYNNE BROCK DAVID BROCK 111 <br /> Mailing address 4145 CALLOWAY CT 4145 CALLOWAY CT 113 <br /> STOCKTON, CA 952152400 STOCKTON, CA 95215-2400 114, 115,116 <br /> Work phone 209-931-3626 209-931-3626 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010980 <br /> Facility name G&L BROCK CONSTRUCTION CO INC G&L BROCK CONSTRUCTION CO INC 3 <br /> Site address 4145 CALLOWAY CT 4145 CALLOWAY CT 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 952152420 95215-2420 105 <br /> Facility phone 209-931-3626 (209) 931-3626 102 <br /> Facility mailing address 4145 CALLOWAY CT 4145 CALLOWAY CT 108a <br /> STOCKTON, CA 952152400 STOCKTON, CA 95215-2400 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name G&L BROCK CONSTRUCTION CO INC G&L BROCK CONSTRUCTION CO INC 140 <br /> Address 4145 CALLOWAY CT 4145 CALLOWAY CT 143 <br /> STOCKTON, CA 952152400 STOCKTON, CA 95215-2400 144, 145, 146 <br /> Contact phone Not Specified 209-931-3626 141 <br /> Contact email lisa@brockconstruction.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG 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 /> �/ <br /> Accounting: Reviewed by: Date: 9 A Clerical: [�] File [ ] Relabel file [ ] Create new file <br /> ------- [ ] Acc 'lied ] Surch 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 PRO520586 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PRO514480 Fatina Zareef Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510980 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0535539 Fatina Zareef Active,Exempt [ ] I 1 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PR0532623 not assigned Inactive [ ] [ ] <br />