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SAN JOAQU .AUNTY ENVIRONMENTAL HEALT EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> I- __ 4/6/2015 <br /> Submitted on: 3/13/2015 9:40:31AM CERS ID: 10481716 <br /> Submitted by: SENGPANYA SPHABMIXAY Email: ssphabmixay@kellymoore.com Facility ID in CERS: incorrect <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0020049 <br /> Owner name KELLY-MOORE PAINT CO. INC. KELLY-MOORE PAINT CO. INC. 111 <br /> Mailing address 987 COMMERCIAL ST. / 987 COMMERCIAL ST. 113 <br /> SAN CARLOS, CA 94070 ✓ SAN CARLOS, CA 94070 114, 115, 116 <br /> Work phone 650-592-8337 650-592-8337 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022521 <br /> Facility name Kelly-Moore Paints Kelly-Moore Paints 3 <br /> Site address 3206 E Hammer Ln Ste A 3206 E Hammer Ln Ste A 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95212 95212 105 <br /> Facility phone 209-474-3706 209-474-3706 102 <br /> Facility mailing address 987 COMMERCIAL ST ATT: ROBERT STETSON, 987 COMMERC 108a <br /> SAN CARLOS, CA 94070 SAN CARLOS, CA 94070 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name KELLY-MOORE PAINTS PAT TORNINCASA 140 <br /> Address 987 COMMERCIAL ST ✓ 987 COMMERCIAL ST. 143 <br /> SAN CARLOS, CA 94070 SAN CARLOS, CA 94070 144, 145, 146 <br /> Contact phone 650-610-4179 650-610-4179 141 <br /> Contact email PTORNINCASA@KELLYMOORE.COM PTORNINCASA@KELLYMOORE.COM 142 <br /> Mail invoices to F teility- <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP <br /> [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar yearnext calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: ,V�^�+ Date: "I' (0'K <br /> ---------------- ________ __ <br /> Accounting: Reviewed by: "G [ Date: 57ie�f/s Clerical: rile [ ] 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 /> 2220-SM HW GEN<5 TONSNR PR0539403 FATINAH ZAREEF Active I 1 t 1 <br /> 1921 -HMBP-Regular-Primary Location PRO539404 HAZA SAEED Inactive [ I [ ] <br />