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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 518!201$ <br /> Subml#ted on: 2/20/2018 3:37:17PM CERS ID: 10183951 <br /> Submitted by: K.J Maddox Email: kjm@pacstatespetro.com Facility ID in CERS: FA0010937 <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 OW0008937 <br /> Owner name PACIFIC STATES PETROLEUM Kevin Maddox 111 <br /> Mailing address PO BOX 2389 PO BOX 2389 113 <br /> PLEASANT HILL, CA 94523 PLEASANT HILL, CA 94523 114, 115, 116 <br /> Work phone 925-988-9970 800-679-1700 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010937 <br /> Facility name PACIFIC STATES PETROLEUM PACIFIC STATES PETROLEUM 3 <br /> Site address 2225 NAVY DR 2225 NAVY DR 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95206 95206 105 <br /> Facility phone 925-988-9970 (925) 988-9970 0 102 <br /> Facility mailing address PO BOX 2389 PO BOX 2389 108a <br /> PLEASANT HULL, CA 94523 PLEASANT HILL, CA 94523 108e, 1o8c,io8d <br /> BILLING INFORMATION <br /> Contact name PACIFIC STATES PETROLEUM Kelli Torres 140 <br /> Address PO BOX 2389 PO BOX 2389 143 <br /> PLEASANT HILL, CA 94523 PLEASANT HILL, CA 94523 144, 145, 146 <br /> Contact phone Not Specified 800-679-1700 141 <br /> Contact email kelli@pacstatespetro.com 142 <br /> Mail invoices to Owner <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: Date: <br /> Accounting: Reviewed by: Date: J i q ( Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMBP-Regular-Primary Location 2 chem units PR0521210✓ ROBERT LOPEZ Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSIYR PRO531126 CESAR RUVALCABA Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513225 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510937 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0528316 STACY RIVERA Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE R PR0533245 not assigned Inactive [ ] [ ] <br />