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SAN JOAQUh -�:OUNTY ENVIRONMENTAL HEALTF,--.;PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/112014 <br /> Submitted on: 11/2112014 9:24:18AM CERS ID: 10182903 <br /> Submitted by: Dominic Alexander Email: domtalexander@gmail.com Facility ID in CERS FA0009784 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0007784 <br /> Owner name DENNIS ALEXANDER DENNIS ALEXANDER 111 <br /> Mailing address 18678 N HWY 99 18678 N HWY 99 113 <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 114, 115, 11E <br /> Work phone 209-368-3160 209-334-9112 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009784 <br /> Facility name CALIFORNIA CONCENTRATE CO CALIFORNIA CONCENTRATE CO 3 <br /> Site address 18678 N HWY 99 18678 N HWY 99 103 <br /> City ACAMPO ACAMPO 104 <br /> ZIP code 95220 95220 105 <br /> Facility phone 209-334-9112 (209) 334-9112 0 102 <br /> Facility mailing address 18678 N HWY 99 18678 N HWY 99 108a <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 108b,108c,10E <br /> BILLING INFORMATION <br /> Contact name CALIFORNIA CONCENTRATE CO CALIFORNIA CONCENTRATE CO 140 <br /> Address 18678N HWY 99 18678N HWY 99 143 <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 144, 145, 14E <br /> Contact phone Not Specified 209-334-9112 141 <br /> Contact email 142 <br /> Mail invoices to Oar <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: 05-3 cit j`( <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: -2-27c <br /> Assigned to: 1,,e- <br /> Please bill: [ ] full calendar year [ J prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: _t L1 1 <br /> Accounting: Reviewed by: Date: t� 3 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> A filled Surcha rifle B : Date: <br /> t ] s ti - _- - v - <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 PRO519872 JAMIE DE LA ROSA Active [ ] [ ] <br /> 1962-CaIARP PROGRAM 2 FACILITY PRO 527101 RAYMOND VON FLUE Active [ J [ ] <br /> 1995-CaIARP FAC STATE SURCHARGE FEE PRO518935 HAZ MAT SJC OES Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509784 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO528394 ARES VELOSO Inactive [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO535738 AMANDA BOERTIEN Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531287 not assigned Inactive [ ] [ ] <br />