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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/11/2014 <br /> Submitted on: 5/19/2014 8:17:39PM CERS ID: 10444366 <br /> Submitted by: Kathy Hieb Email: Kathy.Hieb@wildlife.ca.gov Facility ID in CERS: FA0022229 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0008065 <br /> Owner name CALIFORNIA DEPT FISH &WILDLIFE California Department of Fish and Wildlife 111 <br /> Mailing address 2109 ARCH AIRPORT RD STE 100 1416 Ninth Street 113 <br /> STOCKTON, CA 95206 Sacramento, CA 95814 114,115,116 <br /> Work phone 209-640-4642 916-653-7667 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022229 <br /> Facility name CALIFORNIA DEPT OF FISH &WILDLIFE California Department of Fish and Wildlife 3 <br /> Site address 2109 ARCH AIRPORT RD STE 100 2109 Arch Airport Rd Ste 100 103 <br /> City STOCKTON Stockton 104 <br /> Zip code 95206 95206 105 <br /> Facility phone 209-234-3430 209-234-3430 102 <br /> Facility mailing address 2109 ARCH AIRPORT RD STE 100 2109 Arch Airport Rd Ste 100 108a <br /> STOCKTON, CA 95206 Stockton, CA 95206 10eb,108c,108d <br /> BILLING INFORMATION <br /> Contact name CALIFORNIA DEPT OF FISH &WILDLIFE Kathy Hieb 140 <br /> Address 2109 ARCH AIRPORT RD STE 100 2109 Arch Airport Rd Ste 100 143 <br /> STOCKTON, CA 95206 Stockton, CA 95206 144, 145, 146 <br /> Contact phone Not Specified 209-234-3486 141 <br /> Contact email Kathy.Hieb@wildlife.ca.gov 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG 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:+Aee �Date: ' - Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> 3;,,cd 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 /> 1921 -HMBP-Regular-Primary Location PRO538715 ROBERT LOPEZ Active [ ] [ ] <br /> 1962-CaIARP PROGRAM 2 FACILITY PR0538790 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 1995-CaIARP FAC STATE SURCHARGE FEE PR0538791 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0538714 STACY RIVERA Active 11 [ ] <br />