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E7SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/19/2014 <br /> Submitted on: 5/13/2014 2:00:22PM <br /> Submitted by: Kiumars Khajevandi Email: kkhajevand]@att.net CERS 1 <br /> Facility ID in CERS: FA000 A0000485 <br /> 485 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0005718 <br /> Owner name AMIRI, HALEH BOKIDES FAMILY LTD <br /> Mailing address 1809 SCHOOL ST PO BOX 1411 111 <br /> MORAGA, CA 94556WOODRIDGE, CA 95258 114, 1153116 <br /> Work phone 209-334-1873 (209) 334 0975 <br /> 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000485 <br /> Facility name FLAG CITY CHEVRON FLAG CITY CHEVRON <br /> Site address 6421 CAPITOL AVE 6421 CAPITOLAVE 3 <br /> City LOD] 103 <br /> LODI <br /> Zip code 95242 LODI 104 <br /> Facility phone 209-334-1873 95242 105 <br /> (209) 334-1873 102 <br /> Facility mailing address 6421 CAPITOL AVE 6421 CAPITOL AVE 108a <br /> LODI, CA 95242 LOD], CA 95242 108b,10ec,toed <br /> BILLING INFORMATION <br /> Contact name FLAG CITY CHEVRON FLAG CITY CHEVRON 140 <br /> Address 6421 CAPITOLAVE 6421 CAPITOLAVE 143 <br /> LODI, CA 95242 LODI, CA 95242 144, 145, 146 <br /> Contact phone 209-334-1873 (209) 334 0975 141 <br /> Contact email <br /> Mail invoices to Facility ✓ 142 <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA <br /> [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] /next calendar year [ j exempt from billing <br /> Processed through CERS Integration Wizard by: A Date: !� t�' <br /> ------ ----- ----------- _ <br /> Accounting: 1/0 <br /> Reviewed by:_ Date:lQ1/,h JK Clerical: F[[e [ ] Relabel file [ ] Create new file <br /> [ ] AcrWlled [ ] Surci ve-riiiiie`dd V ' 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 /> 1615-RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PREP; PRO160308 NICHOLAS WIESEMAN Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0520517 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0519074 ARIS VELOSO Active [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PR0515536 MICHAEL KITH Inactive [ ] [ ] <br /> 2361 -UST FACILITY PR0231706 ARTS VELOSO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507248 MICHAEL KITH Inactive [ ] [ ] <br />