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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/13/2017 <br /> Submitted on: 11/29/2017 2:51:06PM CERS ID: 10187395 <br /> Submitted by: Hien Nguyen Email: anguyen212@gmail.com Facility ID in CERS: FA0019859 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0016289 <br /> Owner name NGUYEN, HIEN VAN Chau Cuong 111 <br /> Mailing address 2717 BIRCHWOOD CT 1807 E. CHEROKEE RD, STE 1 113 <br /> STOCKTON, CA 95210 Stockton, CA 95206 114, 115, 116 <br /> Work phone Not Specified 9162129258 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019859 <br /> Facility name CC AUTO REPAIR C.C. AUTO REPAIR BODY& PAINT 3 <br /> Site address 1807 E CHEROKEE RD STE 1 &2 1807 E CHEROKEE RD STE 1 &2 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone Not Specified 2098513914 102 <br /> Facility mailing address 2717 BIRCHWOOD CT 2717 Birchwood Ct 108a <br /> STOCKTON, CA 95210 Stockton, CA 95210 toab,toac,load <br /> BILLING INFORMATION <br /> Contact name CC AUTO REPAIR Hien Nguyen 140 <br /> Address 2717 BIRCHWOOD CT 2717 Birchwood Ct 143 <br /> STOCKTON, CA 95210 Stockton, CA 95210 144, 145, 146 <br /> Contact phone Not Specified 2099814593 141 <br /> Contact email anguyen212@gmail.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: '/owb Date: <br /> -------------------------------------------------- <br /> Accounting: Reviewed by: � Date: 1:211511 -7 rClerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials 5 chem units PR0542237 JAMIE LIMA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0530489 THREE VACANT3 Active [ ] [ ] <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO530490 JEFFREY WONG Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534345 not assigned Inactive [ ] [ ] <br /> I _ p° a) P�v <br />