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F— SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/14/2015 <br /> Submitted on: 1/9/2015 10:48:16AM CERS ID: 10180667 <br /> Submitted by: Paul Canepa Email: canepa0@yahoo.com Facility ID in CERS: FA0000799 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000629 <br /> Owner name CANEPA, REMO J Marion Canepa 111 <br /> Mailing address 642 N HUNTER ST 642 N HUNTER ST 113 <br /> STOCKTON, CA 95202 STOCKTON, CA 95202 114, 115, 116 <br /> Work phone 209-478-5515 2094656114 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000799 <br /> Facility name CANEPAS CAR WASH STORE CANEPAS CAR WASH STORE 3 <br /> Site address 642 N HUNTER ST 642 N HUNTER ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95202 95202 105 <br /> Facility phone 209-948-1636 (209)948-1636 <br /> 102 <br /> Facility mailing address 642 N HUNTER ST 642 N HUNTER ST 108a <br /> STOCKTON, CA 95202 STOCKTON, CA 95202 108b,1o8c,load <br /> BILLING INFORMATION <br /> Contact name CANEPAS CAR WASH STORE CANEPAS CAR WASH STORE 140 <br /> Address 642 N HUNTER ST 642 N HUNTER ST 143 <br /> STOCKTON, CA 95202 STOCKTON, CA 95202 144,145, 146 <br /> Contact phone 209-948-1636 / 2099481636 141 <br /> Contact email I/ 142 <br /> Mail invoices to ill <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 /> Processed through CERS Integration Wizard by: q?n Date: 111,4115- <br /> ---------------------- <br /> [[41/,S---------------------- ------------------------- <br /> Accounting: Reviewed by: • -20L Date:�P-6041S- Clerical: [ ] File [ ] 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 /> 1616-RETAIL MARKET<1000 SQ FT W/FOOD PREP PRO163198 LEYNA HUYNH Active ] ] [ ] <br /> 1921-HMBP-Regular-Primary Location PR0519725 ROBERT LOPEZ Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0526834 JEFFREY WONG Active [ ] [ ] <br /> 2361 -UST FACILITY PR0231148 JEFFREY WONG Active <br /> 2301 -UST STATE SURCHARGE FEE PR0515538 LETITIA BRIGGS Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507263 LETITIA BRIGGS Inactive ( ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533672 not assigned Inactive <br /> I 14 � IS I VLo pc, S& CL LA&L L/ o V-\ S <br /> w ` f ve <br />