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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 9/29/2015 <br /> Submitted on: 9/21/2015 10:06:30AM CERS ID: 10184373 <br /> Submitted by: Brian Duncan Email: bduncan@centralvalleyconcrete.com Facility ID in CERS: FA0013509 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0010638 <br /> Owner name JOHN R LAWSON ROCK& OIL JOHN R LAWSON ROCK& OIL 111 <br /> Mailing address 10848 S HARLAN RD 10848 S HARLAN RD 113 <br /> FRENCH CAMP, CA 95231 FRENCH CAMP, CA 95231 114, 115, 116 <br /> Work phone 800-843-6717 209) 983-0951 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013509 <br /> Facility name JOHN R LAWSON ROCK& OIL JOHN R LAWSON ROCK& OIL 3 <br /> Site address 10848 S HARLAN 10848 S HARLAN 103 <br /> City FRENCH CAMP FRENCH CAMP 104 <br /> ZIP code 95231 95231 105 <br /> Facility phone 209-983-0951 (209) 983-0951 0 102 <br /> Facility mailing address 10848 S HARLAN RD 10848 S HARLAN RD 108a <br /> FRENCH CAMP, CA 95231 FRENCH CAMP, CA 95231 108b,10ac,10ed <br /> BILLING INFORMATION <br /> Contact name JOHN R LAWSON ROCK &OIL JOHN R LAWSON ROCK& OIL 140 <br /> Address 10848 S HARLAN RD 5723 N Golden State BLVD 143 <br /> FRENCH CAMP, CA 95231 Fresno, CA 93722 144, 145, 146 <br /> Contact phone Not Specified (559)276-2220 141 <br /> Contact email 142 <br /> Mail invoices to Oww/er �} <br /> Program record [ ] HMBP ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: Q(Z-054040 - <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: ZZ2-0 <br /> Assigned to: -fZA'-1 <br /> Please bill: [ ] full calendar year 9prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: U-1 lIDate: q•V9 t <br /> -------------------------------------------------- <br /> Accounting: Reviewed by: 4 ) Date: 1/3411 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 /> 1920-HMBP-Common Materials PRO520898 JAMIE DE LA ROSA Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523781 BENJAMIN ESCOTTO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO517577 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534348 not assigned Inactive [ ] [ ] <br />