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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/712017 <br /> Submitted on: 716/2017 10:05:31AM CERS ID: 10722475 <br /> Submitted by: Roberto Merlos Email: robertomerlos90@yahoo.com Facility ID in CERS: FA0015483 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner : T <br /> Owner ID OW0012436 <br /> Owner name roberto merlos roberto merlos 111 <br /> Mailing address 435 n harrison st 435 n harrison st 113 <br /> Stockton, CA 95203 Stockton, CA 95203 114, 115, 116 <br /> Work phone 209-943-1040 209 943-1040 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015483 <br /> Facility name DOMENICS AUTO TECH DOMENICS AUTO TECH 3 <br /> Site address 435 N HARRISON ST 435 N HARRISON ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95203 95203 105 <br /> Facility phone 209-943-1040 209 943-1040 102 <br /> Facility mailing address 435 n harrison st 435 n harrison st 108a <br /> stockton, CA 95203 stockton, CA 95203 108b, 108c, 10ed <br /> BILLING INFORMATION <br /> Contact name robwero merlos robwero merlos 140 <br /> Address 435 n harrison st 435 In harrison st 143 <br /> stockton, CA 95203 stockton, CA 95203 144, 145, 146 <br /> Contact phone 209-943-1040 209 943-1040 141 <br /> Contact email robertomerlos90@yahoo.com robertomerlos90@yahoo.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] 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 /> 7 <br /> Processed through CERS Integration Wizard by: v`" Date: —� <br /> Accounting: Reviewed by: Date: 711' 10 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ j Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status_ Reactivated Inactivated <br /> 1920-HMBP-Common Materials 2 chem units OR0522712 ROBERT LOPEZ Active <br /> 2220-SM HW GEN<5 TONS/YR PRO541n563 STA`CY <br /> RIVER�A � Active <br /> no,[ - '� r11`0 <br /> ] [ <br /> V n <br />