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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 3/13/2015 Submitted on: 3/12/2015 2:10:13PM CERS ID: 10181557 Submitted by: Mike Eliason Email: mike.eliason@vpps.net Facility ID in CERS: FA0003976 Information prior to CIW processing Information after CIW processing CERS OWNER INFORMATION (current EC database) (current submittal) field Owner ID OW0002930 Owner name Valley Pacific Petroleum VALLEY PACIFIC PETROLEUM SERVICE! 111 Mailing address 1512 WEISS WAY 166 FRANK WEST CR 113 ESCALON, CA 95320 STOCKTON, CA 95206 114, 115, 116 Work phone 209-948-9412 (209) 948-9412 112 FACILITY FILE INFORMATION Facility ID FAD003976 Facility name VALLEY PACIFIC CHARTER WAY CARDLC VALLEY PACIFIC CHARTER WAY CARDLC 3 Site address 1501 W CHARTER WAY 1501 W CHARTER WAY 103 City STOCKTON STOCKTON 104 ZIP code 95206 95206 105 Facility phone 209-948-9412 (209) 948-9412 102 Facility mailing address 166 FRANK WEST CIR 166 FRANK WEST CIR 108a STOCKTON, CA 95206 STOCKTON, CA 95206 1o8b, 1oac,1o8d BILLING INFORMATION Contact name VALLEY PACIFIC CHARTER WAY CARDLC VALLEY PACIFIC CHARTER WAY CARDLC 140 Address 166 FRANK WEST CIR 166 FRANK WEST CIR 143 STOCKTON, CA 95206 STOCKTON, CA 95206 144, 145, 146 Contact phone 209-948-9412 (209) 948-9412 141 Contact email 142 Mail invoices to Account Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: UNA Date: 3.13't ------------ -- Accounting: Reviewed by: � Date: 3�)Blis Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] Acct billed [ ] Surcharge verified By: Date: — — - -— — - - —— —— - ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 1926-HMBP-Unstaffed Network Location PRO513010 ROBERT LOPEZ Active [ ] [ ] 2220-SM HW GEN<5 TONS/YR PR0522755 STACY RIVERA Active [ ] [ ] 2361 -UST FACILITY PR0231989 STACY RIVERA Active [ ] [ ] 2301 -UST STATE SURCHARGE FEE PR0507707 MICHAEL KITH Inactive [ ] [ ] 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507555 MICHAEL KITH Inactive [ ] [ ] ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533009 not assigned Inactive [ ] [ ]