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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/14/2017 <br /> Submitted on: 6/13/2017 3:18:30PM CERS ID: 10187165 <br /> Submitted by: Scott Montgomery Email: smontgomery@clarkpest.com Facility ID in CERS: FA0019285 <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 OW0015827 <br /> Owner name Jae Clark Joe Clark 111 <br /> Mailing address 555 North Guild Avenue 555 North Guild Avenue 113 <br /> Lodi, CA 95240 Lodi, CA 95240 114, 115, 116 <br /> Work phone 209-368-7152 (209) 368-7152 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019285 <br /> Facility name CLARK PEST CONTROL INC CLARK PEST CONTROL INC 3 <br /> Site address 4827 Clowes Rd 4827 CLOWES RD 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95210 95210 105 <br /> Facility phone 209-474-3204 (209) 474-3204 102 <br /> Facility mailing address 4816 Clowes Street 4816 Clowes Street 108a <br /> Stockton, CA 95210 Stockton, CA 95210 108e, 108c, 108d <br /> BILLING INFORMATION <br /> Contact name Dave Shewmake Tony Garcia 140 <br /> Address 4816 Clowes Street 4816 Clowes Street 143 <br /> Stockton, CA 95210 Stockton, CA 95210 144, 145. 146 <br /> Contact phone 209-474-3204 (209)474-3204 141 <br /> Contact email dshewmake@clarkpest.com tgarcia@clarkpest.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year f ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: r'N ['�q-- Date: �- 17 <br /> ----- <br /> Accounting: Reviewed by � Date: � Clerical: [ ] 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 /> 1921 -HMBP-Regular-Primary Location 5 cherll L. lts PR0528722 JAMIE LIMA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0539204 VICKI MCCARTNEY Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0540192 HARPRIT MATTLI Active [ ] ( ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534151 not assigned Inactive [ ] [ ] <br />