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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/17/2016 Submitted on: 6/16/2016 2:01:48PM CERS ID: 10001884 Submitted by: Don Lynch Email: donald.lynch@dot.ca.gov Facility ID in CERS: FA0009376 Information prior to CIW processing Information after CIW processing CERS OWNER INFORMATION (current EC database) (current submittal) field Number of Facilities for this Owner: 10 Owner ID OW0001008 Owner name STATE OF CALIFORNIA/DEPT OF TRANSI State of California 111 Mailing address PO BOX 2048 P O Box 2048 113 STOCKTON, CA 95201 Stockton, CA 95201 114, 115, 116 Work phone 209-948-3723 209-948-7409 112 FACILITY FILE INFORMATION Facility ID FA0009376 Facility name Caltrans-District 10 Office Caltrans-District 10 Office 3 Site address 1976 E Charter Way 1976 E Charter Way 103 City Stockton Stockton 104 ZIP code 95205 95205 105 Facility phone 209-948-7543 209-948-7543 102 Facility mailing address P O Box 2048 P O Box 2048 108a Stockton, CA 95201 Stockton, CA 95201 108b,108c,load BILLING INFORMATION Contact name Don Lynch Don Lynch 140 Address P O Box 2048 P O Box 2048 143 Stockton, CA 95221 Stockton, CA 95221 144, 145, 146 Contact phone 209-948-7409 209-948-7409 141 Contact email donald.lynch@dot.ca.gov donald.lynch@dot.ca.gov 142 Mail invoices to Account Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: _Date: �E I]�Ii(P --------------- -------- Accounting: Reviewed by: tA? Date: ]P "1(le Clerical: [ ] File [ ] Relabel file [ ] Create new file By: Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 1920-HMBP-Common Materials PR0519589 HAZA SAEED Active [ J [ ] 2220-SM HW GEN<5 TONS/YR PR0513800 STACY RIVERA Active [ ] [ ] 4740-WASTE TIRE SITE-EXEMPT PR0523689 FRANK GIRARDI Active [ ] [ ] 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0500379 LETITIA BRIGGS Inactive [ ] [ ] 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0500385 LETITIA BRIGGS Inactive [ ] [ ] 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0509376 HAZ MAT SJC DES Inactive [ ] [ ] ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531897 not assigned Inactive [ ] [ ]