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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 3/19/2015 <br /> Submitted on: 1/27/2015 9:46:21AM CERS ID: 10181515 <br /> Submitted by: Juan Espinoza Email:juan.espinoza@boral.com Facility ID in CERS: FA0003917 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0002896 <br /> Owner name BORAL ROOFING BORAL ROOFING 111 <br /> Mailing address 7575 Irvine Center Drive#100 7575 Irvine Center Drive#100 113 <br /> Irvine, CA 92618 Irvine, CA 92618 114, 115,116 <br /> Work phone 949-756-1605 (949) 756-1605 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003917 <br /> Facility name BORAL ROOFING BORAL ROOFING 3 <br /> Site address 9508 HARLAN RD 9508 HARLAN RD 103 <br /> City FRENCH CAMP FRENCH CAMP 104 <br /> ZIP code 95231 95231 105 <br /> Facility phone 209-982-1473 (209) 982-1473 102 <br /> Facility mailing address 9508 HARLAN RD 9508 HARLAN RD 1082 <br /> FRENCH CAMP, CA 95231 FRENCH CAMP, CA 95231 108b, 108c 108d <br /> BILLING INFORMATION <br /> Contact name Juan Espinoza Juan Espinoza 140 <br /> Address 9508 HARLAN RD 9508 HARLAN RD 143 <br /> FRENCH CAMP, CA 95231-9625 FRENCH CAMP, CA 95231-9625 144, 145, 146 <br /> Contact phone 209-982-1473 (209) 982-1473 x 8670 141 <br /> Contact email juan.espinoza@boral.com juan.espinoza@boral.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG 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 /> Processed through CERS Integration Wizard by: nt✓� Date: <br /> ------------------------------------------------ <br /> Accounting: Reviewed by:_ }'Y:;' Date: ''I Z3) (< Clerical: [ ] File [ ] Relabel file ( ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified B : <br /> ------ Date: <br /> ———---y— -- <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 PR0519580 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO513790 THUY TRAN Active [ ] [ ] <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PRO535860 THUY TRAN Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524497 BENJAMIN ESCOTTO Active [ ] [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231588 STEVE SASSON Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509364 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533793 not assigned Inactive [ ] [ ] <br />