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I:::_ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/222015 <br /> Submitted on: 1/9/2015 10:38:46AM CERS ID: 10183067 <br /> Submitted by: Karen Moecker Email: kmoecker@bfrc.com <br /> Facility ID in CERS: FA0009957 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0007957 <br /> Owner name Bridgestone Retail Operations, LLC Bridgestone Retail Operations, LLC 111 <br /> Mailing address 333 East Lake Street Attn: Debra Hamlin 333 East Lake Street Attn: Karen Moeck 113 <br /> Bloomingdale, IL 60108 Bloomingdale, IL 60108 114, 115, 116 <br /> Work phone 630-259-9000 630-259-9000 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009957 <br /> Facility name Firestone Complete Auto Care#3583 Firestone Complete Auto Care#028746 3 <br /> Site address 720 E HAMMER LN 720 E HAMMER LN 1 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95210 95210 105 <br /> Facility phone 209-951-2403 209-951-2403 102 <br /> Facility mailing address 333 East Lake Street Attn: Debra Hamlin-B 333 East Lake Street Attn: Karen Moecki 108a <br /> Bloomingdale, IL 60108 Bloomingdale, IL 60108 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name Debra Hamlin-BSRO Karen Moecker-BSRO 140 <br /> Address 333 East Lake Street / 333 East Lake Street 143 <br /> Bloomingdale, IL 60108 Bloomingdale, IL 60108 144, 145, 146 <br /> Contact phone 630-259-9379 630-259-9216 141 <br /> Contact email envgen@bfenvgen@bfrc.com 142 <br /> Mai[ invoices to Account <br /> rc.co <br /> Program record [ ] HMBP [ ] SQG HW [ I LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> hiProcessed through CERS Integration Wizard by: l Date: d x-I <br /> ---------------�r—D-------------------------------- -- <br /> Accounting: Reviewed by: L. v Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> -------------------------------------------------- <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 PR0519988 HAZA SAEED Active [ ] [ ] <br /> 2228-GEN 25<50 TONS PERMIT PR0514108 FATINAH ZAREEF Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO522401 HARPRIT MATTU Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509957 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531981 not assigned Inactive [ ] [ ] <br />