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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/15/2014 <br /> Submitted on: 12/11/2014 9:51:08AM CERS ID: 10001884 <br /> Submitted by: Don Lynch Email: donald.lynch@dot.ca.gov Facility ID in CERS: FA0009376 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001008 <br /> Owner name Caltrans State of California 111 <br /> Mailing address P.O. Box 2048 P O Box 2048 113 <br /> Stockton, CA 95201 Stockton, CA 95201 114, 115, 11E <br /> Work phone 209-948-3723 209-948-7409 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009376 <br /> Facility name Caltrans-District 10 Office Caltrans-District 10 Office 3 <br /> Site address 1976 E Charter Way 1976 E Charter Way 103 <br /> City Stockton 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone 209-948-7543 209-948-7543 102 <br /> Facility mailing address P O Box 2048 Stockton P O Box 2048 108a <br /> Stockton, CA 95201 Stockton, CA 95201 108b,108c,10e <br /> BILLING INFORMATION <br /> Contact name Don Lynch Don Lynch 140 <br /> Address P O Box 2048 P O Box 2048 143 <br /> Stockton, CA 95221 Stockton, CA 95221 144, 145, 14E <br /> Contact phone 209-948-7409 209-948-7409 141 <br /> Contact email donald.lynch@dot.ca.gov donald.lynch@dot.ca.gov 142 <br /> Mail invoices to Gw"Vj / <br /> Program record [ ] HMBP [ ] SCIG HW [ ] LOG 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: fl/-f Date: 1z j i5_1T 4 <br /> Accounting: Reviewed by: _4pc—Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acc d [ ] Surcharge—verified By: 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 PR0519589 HAZASAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0513800 STACY RIVERA Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0523689 FRANK GIRARDI Active [ ] [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO500379 LETITIA BRIGGS Inactive [ ] [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0500385 LETITIA BRIGGS Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0509376 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531897 not assigned Inactive [ ] [ ] <br />