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SAN JOAQUIj,. BOUNTY ENVIRONMENTAL HEALTHMPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/30/2015 <br /> Submitted on: 11/24/2015 10:40:59AM CERS ID: 10187099 <br /> Submitted by: Debbie Livermore Email: debbie.livermore@stocktongov.com Facility ID in CERS: FA0019198 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner : 9 <br /> Owner ID OW0012870 <br /> Owner name City of Stockton CITY OF STOCKTON 111 <br /> Mailing address 425 N. EI Dorado Street 425 N. ELDORADO STREET 113 <br /> STOCKTON, CA 95202 STOCKTON, CA 95202 114, 115, 116 <br /> Work phone 209-937-8341 209-937-8341 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019198 <br /> Facility name SPANOS WEST (FAKLIS PARK) SPANOS WEST (FAKLIS PARK) 3 <br /> Site address 5250 COSUMNES DR 5250 COSUMNES DR 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95219 95219 105 <br /> Facility phone 209-837-8377 (209) 837-8700 102 <br /> Facility mailing address 2500 NAVY DR 2500 NAVY DR 108a <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 108b, 108c, 108d <br /> BILLING INFORMATION <br /> Contact name SPANOS WEST (FAKLIS PARK) CITY OF STOCKTON - MUD 140 <br /> Address 2500 NAVY DR 2500 NAVY DR 143 <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 144, 145, 146 <br /> Contact phone 209-937-8700 209-937-8700 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 this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: i4` Date: <br /> ---------------------------- - -- ----- - <br /> Accounting: Reviewed by: A Date: )z i 1� 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 Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstaffed Network Location PR0537207 HAZA SAEED Active [ ] [ ] <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATIVE PRO528526 FATINAH ZAREEF Inactive [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533454 not assigned Inactive [ ] [ ] <br /> I <br />