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J <br /> ink 40 <br /> SAN JOAQUI COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6!27/2014 <br /> Submitted on: 5/23/2014 3:59:57PM CERS ID: 10184681 <br /> Submitted by: Ralph Colonna Email: r.colonna@fleetwash.com Facility ID in CERS: FA0014454 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0011496 <br /> Owner name FLEETWASH FLEETWASH 111 <br /> Mailing address PO BOX 1577 26 law drive Unit E 113 <br /> W CALDWELL, NJ 07007 Fairfield, NJ 07007 114, 115, 116 <br /> Work phone 800-847-3735 800-847-3735 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014454 <br /> Facility name FLEETWASH FLEETWASH 3 <br /> Site address 1162 BESSEMER AVE#2 1162 BESSEMER AVE#2 103 <br /> City MANTECA MANTECA 104 <br /> Zip code 95337 95337 105 <br /> Facility phone 209-823-8775 (209)823-8775 102 <br /> Facility mailing address PO BOX 1577 PO BOX 1577 108a <br /> W CALDWELL, NJ 07007 W CALDWELL, NJ 07007 108b,108c,load <br /> BILLING INFORMATION <br /> Contact name FLEETWASH Fleetwash Inc. 140 <br /> Address PO BOX 1577 26 law drive Unit E 143 <br /> W CALDWELL, NJ 07007 Fairfield, NJ 07007 144, 145, 146 <br /> Contact phone Not Specified 800-847-3735 141 <br /> Contact email jimmy@fleetwash.com 142 <br /> Mail invoices to Owner <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 [ j prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: (C U yt v Date: 2 6 <br /> Accounting: Reviewed by: l Q_Date:Anr� Clerical: K File [ ] Relabel file [ ] Create new file <br /> [ ] Acct b_ 1tt€8_ [ ] Surc� ___arg�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 /> 1921 -HMBP-Regular-Primary Location PR0519312 MICHAEL PARISSI Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PRO535686 ELENA MANZO Actives <br /> 4740-WASTE TIRE SITE-EXEMPT PRO535074 ALFONSOARAMBULA Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532868 not assigned Inactive [ ] [ ] <br />