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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 5/10/2016 <br /> Submitted on: 3/11/2016 2:44:59PM CERS ID: 10183821 <br /> Submitted by: rodney dove Email: chartertow@aol.com <br /> Facility ID in CERS: FA0010789 <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: 1 <br /> Owner ID OW0008789 <br /> Owner name DOVE, RODNEY DOVE, RODNEY 111 <br /> Mailing address 1234 S AURORA ST 1234 S AURORA ST 113 <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 11a, 115, ns <br /> Work phone 209-339-8456 209-339-8456 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010789 <br /> Facility name CHARTER WAY TOW(AURORA) CHARTER WAY TOW(AURORA) 3 <br /> Site address 1234 S AURORA ST 1234 S AURORA ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95206 95206 <br /> Facility phone 209-948-8500105 <br /> (209) 948-8500 0 102 <br /> Facility mailing address 1234 S AURORA ST 1234 S AURORA ST 108a <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 108b,mac,load <br /> BILLING INFORMATION <br /> Contact name CHARTER WAY TOW (AURORA) CHARTER WAY TOW (AURORA) 140 <br /> Address 1234 S AURORA ST 1234 S AURORA ST 143 <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 144, 145, 146 <br /> Contact phone 209-948-8500 209-948-8500 141 <br /> Contact email 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: t�� 05 117 qK 2— <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: r)--2--LV <br /> Assigned to: V-=j VL-(LA <br /> Please bill: full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: A Date: �;'`o .► b <br /> --- --- -- <br /> Accounting: Reviewed by: U!> Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> —— <br /> [,d Acct billed [ ] Surr hargayPri fes— ok— B Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials PR0521245 ROBERTLOPEZ Active [ I [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510789 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO532259 not assigned Inactive [ ] [ ] <br />