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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/12/2016 <br />Submitted on: 1/4/2016 12:27:54PM CERS ID: 10408567 <br />Submitted by: DAVID CARDOZA Email: CAPTAIN184@MONTEZUMAFIRE.COM Facility ID in CERS: FA0005944 <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 />Number of Facilities for this Owner : 1 <br />OW0004737 <br />MONTEZUMA FIRE DISTRICT <br />2405 S B ST <br />STOCKTON, CA 95206 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0005944 <br />Facility name <br />MONTEZUMA FIRE DISTRICT <br />Site address <br />2405 S B ST <br />City <br />STOCKTON <br />ZIP code <br />95206 <br />Facility phone <br />209-464-5234 <br />Facility mailing address 2405 S B ST <br />STOCKTON, CA 95206 <br />BILLING INFORMATION <br />Contact name MONTEZUMA FIRE DISTRICT <br />Address 2405 S B ST <br />STOCKTON, CA 95206 <br />Information after CIW processing CERS <br />(current submittal) field <br />MONTEZUMA FIRE DISTRICT 111 <br />2405 S. B Street 113 <br />Stockton, CA 95206 114, 115, 116 <br />(209) 464-5234 112 <br />Montezuma Fire District St 18-1 <br />3 <br />2405 S B St <br />103 <br />Stockton <br />104 <br />95206 <br />105 <br />(209) 464-5234 <br />102 <br />2405 S B ST 108a <br />STOCKTON, CA 95206 108b, 108c, 108d <br />MONTEZUMA FIRE DISTRICT STA #18-1 140 <br />2405 S. B Street 143 <br />Stockton, CA 95206 144, 145, 146 <br />Contact phone 209-464-5234 (209) 464-5234 141 <br />Contact email 142 <br />Mail invoices to Facility <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 cthiiss calendar year [ ] next calendar year ['14' exempt from billing <br />Processed through CERS Integration Wizard by: 7'1*"-' Date: <br />Accounting: Reviewed by: b Date: I 15/1 to 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 />2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0503702 LETITIA BRIGGS Inactive I I I I <br />