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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 5/18/2018 <br /> Submitted on: 1/4/2018 1:39:26PM CERS ID: 10187495 <br /> Submitted by: Gerardo Ceja Email: cvccautobody@att.net Facility ID in CERS: FA0020058 <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 OW0016463 <br /> Owner name CENTRAL VALLEY COLLISION INC Ceja Gerardo 111 <br /> Mailing address 24580 S MacArthur Dr. 24580 S MacArthur Dr. 113 <br /> TRACY, CA 95376 TRACY, CA 95376 114, 115, 116 <br /> Work phone 209-830-0561 2098300561 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0020058 <br /> Facility name CENTRAL VALLEY COLLISION INC CENTRAL VALLEY COLLISION CENTER 3 <br /> Site address 24580 S MACARTHUR DR 24580 S MACARTHUR DR 103 <br /> City TRACY TRACY 104 <br /> ZIP code 95376 95376 105 <br /> Facility phone 209-830-0561 (209) 830-0561 102 <br /> Facility mailing address 24580 S MACARTHUR DR 24580 S MACARTHUR DR 108a <br /> TRACY, CA 95376 TRACY, CA 95376 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name CENTRAL VALLEY COLLISION INC Beatriz Ceja 140 <br /> Address 24580 S MACARTHUR DR 24580 S MACARTHUR DR 143 <br /> TRACY, CA 95376 TRACY, CA 95376 144, 145, 146 <br /> Contact phone 209-992-7224 2098300561 141 <br /> Contact email CVCCAUTOBODY@ATT.NET cvccautobody@att.net 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate tt-his calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: f '1 Date: 4�—)o`[q <br /> Accounting: Reviewed by: � Date: s'��•f'�I� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ----------- - -- - - --- ----------- -- - - - -- -- - <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials 1 chem units PR0539201v NICHOLAS LOEHRER Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0531141 BETTY HO Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534377 not assigned Inactive [ ] [ ] <br /> L�U�y� �PP'v�`a �y �, ►J'Lc1��la5���.�rcr, <br />