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E- SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/8/2015 <br /> Submitted on: 3/31/2015 8:39:14AM CERS ID: 10181899 <br /> Submitted by: Heather Fraser Email: heather@sanbornchevrolet.com Facility ID in CERS: FA0005626 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0004451 <br /> Owner name SANBORN CHEVROLET INC Richard E. Sanborn 111 <br /> Mailing address PO BOX 1057 PO BOX 1057 113 <br /> LODI, CA 95241-1057 LODI, CA 95241-1057 114, 115, 116 <br /> Work phone 209-334-5000 2093345000 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0005626 <br /> Facility name SANBORN CHEVROLET INC SANBORN CHEVROLET INC 3 <br /> Site address 1210 S CHEROKEE LN 1210 S CHEROKEE LN 103 <br /> City LODI LODI 104 <br /> ZIP code 95241 95241 105 <br /> Facility phone 209-334-5000 (209) 334-5000 102 <br /> Facility mailing address PO BOX 1057 PO BOX 1057 108a <br /> LODI, CA 95241-1057 LODI, CA 95241-1057 108b, 1080,108d <br /> BILLING INFORMATION <br /> Contact name SANBORN CHEVROLET INC SANBORN CHEVROLET INC 140 <br /> Address PO BOX 1057 PO BOX 1057 143 <br /> LODI, CA 95241-1057 LODI, CA 95241-1057 144, 145, 146 <br /> Contact phone 209-334-5000 2093345000 141 <br /> Contact email heather@sanbornchevrolet.com 142 <br /> Mail invoices to Facility <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 [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: JAA Date: y• �' t <br /> Accounting: Reviewed b : Date: ��/3 1 <br /> y � � Clerical: File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge 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 PR0519414 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2228-GEN 25<50 TONS PERMIT PR0505935 ARTS VELOSO Active [ ] [ ] <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATIVE PR0528318 ARIS VELOSO Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522805 BENJAMIN ESCOTTO Active [ ] [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0502946 FATINAH ZAREEF Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507602 FATINAH ZAREEF Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532289 not assigned Inactive [ ] [ ] <br />