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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/24/2014 <br /> Submitted on: 11/18/2014 2:58:33PM CERS ID: 10185139 <br /> Submitted by Glen Ganotis Email: gleng@jiffylubeca.com Facility ID in CERS: FA0016278 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0002824 <br /> Owner name BROADBASE INC. BROADBASE INC. 111 <br /> Mailing address 1471 SHORE ST 1471 SHORE ST 113 <br /> WEST SACRAMENTO, CA 95691 WEST SACRAMENTO, CA 95691 114, 115, 11E <br /> Work phone 916-375-1155 (918)375-1155 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016278 <br /> Facility name JIFFY LUBE#1478 JIFFY LUBE#1478 3 <br /> Site address 1648 E HAMMER LN 1648 E HAMMER LN 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95210 95210 105 <br /> Facility phone 209-952-8760 (209)957-8730 102 <br /> Facility mailing address 1471 SHORE ST 1471 SHORE ST 108a <br /> WEST SACRAMENTO, CA 95691 WEST SACRAMENTO, CA 95691 108b,108c,10E <br /> BILLING INFORMATION <br /> Contact name JIFFY LUBE#1478 JIFFY LUBE#1478 140 <br /> Address 1471 SHORE ST 1471 SHORE ST 143 <br /> WEST SACRAMENTO, CA 95691 WEST SACRAMENTO, CA 95691 144, 145, 14( <br /> Contact phone 916-375-1155 (916)375-1155 141 <br /> Contact email gleng@jiffylubeca.com gleng@jiffylubeca.com 142 <br /> y <br /> Mail invoices to A <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: U Date: u[z't i; <br /> Accounting: Reviewed by: Date: �7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acobitled [ ] Surchl erl led 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 PR0524482 HAZA SAEED Active <br /> 2229-GEN 50<250 TONS PERMIT PR0524254 FATINAH ZAREEF Active ( ] [ ] <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATIVE PRO527167 FATINAH ZAREEF Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533756 not assigned Inactive [ ] [ ] <br />