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SAN JOAQUINLIUNTY ENVIRONMENTAL HEALTH PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 9/14/2015 <br /> Submitted on: 9/10/2015 10:43:03AM CERS ID: 10183839 <br /> Submitted by: Jeff Kitto Email:jeffkittol @gmail.com Facility ID in CERS: FA0010815 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner lD OW0008815 <br /> Owner name KITTO, JEFF KITTO, JEFF 111 <br /> Mailing address 3307 FAIRWAY DR 3307 FAIRWAY DR 113 <br /> STOCKTON, CA 95204 STOCKTON, CA 95204 114, 115, 116 <br /> Work phone 209-477-4397 209-477-4397 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010815 <br /> Facility name PARKWOODS CLEANERS PARKWOODS CLEANERS 3 <br /> Site address 1901 COUNTRY CLUB BLVD 1901 COUNTRY CLUB BLVD 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95204-4821 95204-4821 105 <br /> Facility phone 209-464-2181 (209) 464-2181 102 <br /> Facility mailing address 3307 FAIRWAY DR 3307 FAIRWAY DR 108a <br /> STOCKTON, CA 95204 STOCKTON, CA 95204 108e, 10ac,load <br /> BILLING INFORMATION <br /> Contact name PARKWOODS CLEANERS PARKWOODS CLEANERS 140 <br /> Address 3307 FAIRWAY DR 3307 FAIRWAY DR 143 <br /> STOCKTON, CA 95204 STOCKTON, CA 95204 144, 145, 146 <br /> Contact phone 209-477-4397 209-477-4397 141 <br /> Contact email jeffki of @gmail.com jeffkittol @gmail.com 142 <br /> Mail invoices to Fa ty <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW j ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year �0, prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> J (� <br /> Processed through CERS Integration Wizard by: VA Date: vl - k�4`�� <br /> Accounting: Rev wed by: � ! '�Date: I L+h5 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> Acct billed [ ] 3orchwgeacerif ed- By. - ——— Date: - -- — <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 PR0520503 ROBERT LOPEZ Active [ ] [ ] <br /> 2220-SM HW GEN <5 TONSIYR PR0514425 FATINAH ZAREEF Inactive [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510815 HAZ MAT SJC OES Inactive ( ] [ 1 <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO522968 GARRETT BACKUS Inactive ( ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533364 not assigned Inactive [ ] [ ] <br /> `�ry,, + <br />