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SAN JOAQUINCOUNTY ENVIRONMENTAL HEALTH-WEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 10/19/2015 <br /> Submitted on: 10/16/2015 2:37:11PM CERS ID: 10646158 <br /> Submitted by: VICTOR LOPEZ Email: vlopez1274@yahoo.com Facility ID in CERS: incorrect <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: 1 <br /> Owner ID OW0013026 <br /> Owner name MCCOY TRUCK TIRE SERVICE CENTE VICTOR LOPEZ 111 <br /> Mailing address 1407 LONE PALM AVE 3430 GRUENSEY AVE 113 <br /> MODESTO, CA 95351 STOCKTON, CA 95205 114, 115, 116 <br /> Work phone 209-521-6221 2095186153 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016127 <br /> Facility name MCCOY TRUCK TIRE SERVICE CENTE TECH TRUCK AND AUTO INC 3 <br /> Site address 3726 S HWY 99 3726 S Hwy 99 East Frontage Rd 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95215 95215 105 <br /> Facility phone 209-466-4551 2099483587 102 <br /> Facility mailing address 1407 LONE PALM AVE 3726 S Hwy 99 East Frontage Rd 108a <br /> MODESTO, CA 95351 STOCKTON, CA 95205 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name MCCOY TRUCK TIRE SERVICE CENTE TERESA FELIX 140 <br /> Address 1407 LONE PALM AVE 3430 GRUENSEY AVE 143 <br /> MODESTO, CA 95351 STOCKTON, CA 95205 144, 145, 146 <br /> Contact phone 209-521-6221 2096881191 141 <br /> Contact email techtrucknauto@gmail.com 142 <br /> Mail invoices to F�aity A, Ike-x)2- 192 <br /> Program record [ ] HMBBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: QUO 5 Lt 0 50 D <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: 22.E <br /> Assigned to: rv'%ArvLZ-) <br /> Please bill: [ ] full calendar year prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> /J <br /> Processed through CERS Integration Wizard by: VA Date: l 0 . t 1 <br /> -- - ------- ----------------------------------- - - - - - <br /> Accounting: Reviewed by: b6 Date: I D 20 l Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> Acct billed [ ] -SurchargcverffiedBy: Date_ <br /> __ <br /> -- — <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status React i ated Inactivated <br /> 1921 -HMBP-Regular-Primary Location PR0524133 JAMIE DE LA ROSA Inactive y [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523974 BENJAMIN ESCOTTO Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531602 not assigned Inactive [ ] [ ] <br /> d, )0/20/l S <br /> LM , ;-7038 $ <br />