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SAN JOAQUINPWIUNTY ENVIRONMENTAL HEALTH WARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/21/2016 <br /> Submitted on: 4PM016 10:13:04AM CERS ID: 10181529 <br /> Submitted by: Sherri Keys Einail: skeys20l2@aol.com Facility ID in CERS: FA0003930 <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 OW0002905 <br /> Owner name LEONARDINI, VIC Vic Leanardini 111 <br /> Mailing address 122 W ALDER ST 11530 W. Eight Mile Road 113 <br /> STOCKTON, CA 95204 Stockton, CA 95219 114, 115, 116 <br /> Work phone 209-470-8187 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003930 <br /> Facility name KING ISLAND MARINA* KING ISLAND MARINA 3 <br /> Site address 11530 W EIGHT MILE RD 11530 W EIGHT MILE RD 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95219 95219 105 <br /> Facility phone 209-477-5364 209-477-5364 102 <br /> Facility mailing address 11530 W EIGHT MILE RD 11530 W. Eight Mile Road 108a <br /> STOCKTON, CA 95219 Stockton, CA 95219 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name KING ISLAND MARINA* Sherri Keys 140 <br /> Address 11530 W EIGHT MILE RD 1530 W. Eight Mile Road 143 <br /> STOCKTON, CA 95219 Stockton, CA 95219 144, 145, 146 <br /> Contact phone 209-477-5364 209-477-5364 141 <br /> Contact email skeys20l2@aol.com 142 <br /> Mai[ invoices to F@cility <br /> Program record [ ] HMBP [ ] SQG 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: AVN Date: b <br /> ------g. ----- — I—Q-- �7---------[ --[ -----[ ----- - <br /> Accountin Reviewed by: Date: �7�s�i 4< Clerical: File Relabel file Create new file <br /> [ ] Acct billed [ ] 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 /> 1921 -HMBP-Regular-Primary Location PRO519841 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN <5 TONS/YR PRO522380 FATINAH ZAREEF Active [ ] [ ] <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PRO516703 FATINAH ZAREEF Active [ ] [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231557 MICHAEL KITH Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507531 MICHAEL KITH Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534220 not assigned Inactive [ ] [ ] <br />