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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard Date run: 11/9/2017 <br />Submitted on: 9/20/2017 3:04:02PM CERS ID: 10400443 <br />Submitted by: ana andrade Email: andradeanac2015@gmail.com Facility ID in CERS: FA0021554 <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />Icurrent EC database) <br />Number of Facilities for this Owner : 1 <br />OW0017719 <br />Juan Carlos Cervantes <br />735 Virginia st <br />Manteca, CA 95336 <br />209-244-8160 <br />FACILITY FILE INFORMATION <br />Information after CIW processing CERS <br />(current submittal) field <br />y/ II� CS <br />Juan CarlosS't` <br />ervamte 111 <br />735 Virginia 113 <br />Manteca, CA 95336 114, 115,116 <br />209-244-8160 112 <br />Facility ID <br />FA0021554 <br />1121 E DR Martin Luther King Blvd JR <br />108a <br />Facility name <br />EI Primo Auto Dismantle <br />EI Primo Auto Dismantle <br />3 <br />Site address <br />1121 E DR MARTIN LUTHER KING JR BLV <br />1121 E Dr Martin Luther King Jr Blvd <br />103 <br />City <br />Stockton <br />Stockton <br />104 <br />ZIP code <br />95205 <br />95205 <br />105 <br />Facility phone <br />209-941-2180 <br />209-905 3330 <br />102 <br />Facility mailing address <br />1121 E DR Martin Luther King Jr Blvd <br />1121 E DR Martin Luther King Blvd JR <br />108a <br />Stockton, CA 95205 <br />Stockton, CA 95205 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name <br />EI Primo Auto Dismantle <br />Juan Carlos Cervantes <br />140 <br />Address <br />1121 E DR Martin Luther King Jr Blvd <br />1121 E DR Martin Luther King Blvd JR <br />143 <br />Stockton, CA 95205 <br />Stockton, CA 95205 <br />144, 145, 146 <br />Contact phone <br />209-244-8160 <br />209-244-8160 <br />141 <br />Contact email <br />jcelprimo@gmail.com <br />elprimoauto20159gmail.com <br />142 <br />Mail invoices to <br />Account <br />Program record [ 1 HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />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: ()%�, % Date: I-00 al7 <br />-------------------------------------------------- <br />Accounting: Reviewed by: (11b Date: /I I q I1-, 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 />1920 - HMBP-Common Materials 3 chem units PR0537470 -/ ROBERT LOPEZ Active [ ] [ 1 <br />2220 - SM HW GEN <5 TONSNR PRO537469 THREE VACANT3 Active [ ] [ 1 <br />7'��v '+-, 0 %-dv- er k y � (A.A r\a, e - 019 0 v V\er J 0 (,sr/ee--k C4 <br />