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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 10/5/2015 <br />Submitted on: 9/29/2015 2:28:27PM <br />Submitted by: Mike Mason Email: mmason@holtca.com <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 />OW0008595 <br />HOLT OF CA <br />PO BOX X <br />SACRAMENTO, CA 95813-1306 <br />916-991-8200 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0010595 <br />Facility name <br />HOLT OF CA <br />Site address <br />1234 W CHARTER WAY <br />City <br />STOCKTON <br />ZIP code <br />95206 <br />Facility phone <br />209-462-3660 <br />Facility mailing address PO BOX X <br />SACRAMENTO, CA 95813-1306 <br />BILLING INFORMATION <br />CERS ID: 10183655 <br />Facility ID in CERS: FA0010595 <br />Information after CIW processing <br />(current submittal) <br />HOLT OF CALIFORNIA <br />PO BOX 100001 <br />Sacramento, CA 95813-1306 <br />916-991-8200 <br />HOLT OF CA <br />1234 W CHARTER WAY <br />STOCKTON <br />95206 <br />(209) 946-6510 <br />P.O. Box "X" <br />Sacramento, CA 95813-1306 <br />Contact name <br />HOLT OF CA <br />Mike Mason <br />Address <br />PO BOX X <br />PO BOX 100001 <br />ROBERT LOPEZ <br />SACRAMENTO, CA 95813-1306 <br />SACRAMENTO, CA 95813-1306 <br />Contact phone <br />916-991-8200 <br />916-921-8917 <br />Contact email <br />Mail invoices to <br />FaAity ',y <br />mmason@holtca.com <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST <br />New PR#: _ <br />New PE: _ <br />Assigned to: <br />CERS <br />field <br />111 <br />113 <br />114, 115, 116 <br />112 <br />3 <br />103 <br />104 <br />105 <br />102 <br />108a <br />108b, 108c, 108d <br />140 <br />143 <br />144, 145, 146 <br />141 <br />142 <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: ADate: [ 0 -S r ( <br />-------------------------------------------------- <br />Accounting: Reviewed by: �� Date: I �� / Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />-------------------------------------------------- <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location <br />PRO512883 <br />ROBERT LOPEZ <br />Active [ ] [ ] <br />2227 - GEN 5<25 TONS PERMIT <br />PRO519075 <br />THUY TRAN <br />Active [ ] [ ] <br />2831 - AST FAC >/= 1,320 - <10 K GAL CUMULATIVE <br />PRO528303 <br />THUY TRAN <br />Active [ ] [ ] <br />4740 - WASTE TIRE SITE - EXEMPT <br />PR0523138 <br />ALFONSO ARAMBULA <br />Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PRO510595 <br />HAZ MAT SJC OES <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0534208 <br />not assigned <br />Inactive [ ] [ ] <br />