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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/5/2016 <br /> Submitted on: 11/29/2016 1:55:27PM CERS ID: 10184921 <br /> Submitted by: saima all Email: mobussar@yahoo.com <br /> Facility ID in CERS: FA0015324 <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 OW0022045 <br /> Owner name ALI, SAIMA Saima Ali 111 <br /> Mailing address 8658 HERITAGE HILL DR 8658 Heritage Hill Dr 113 <br /> ELK GROVE, CA 95624 Elk Grove, CA 114, 115, 116 <br /> Work phone 916 837 3293 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015324 <br /> Facility name N's AUTO + Tires N Auto Plus Tires 3 <br /> Site address 3403 E MAIN ST STE B 3403 E MAIN ST STE B 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone 209-463-8881 209 463 8881 <br /> 102 <br /> Facility mailing address 3403 E MAIN ST STE B 3403 E Main St Ste B 108a <br /> STOCKTON, CA 95205 Stockton, CA 95205 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name N's AUTO + Tires All Moussar 140 <br /> Address 3403 E MAIN ST STE B 8658 Heritage Hill Dr 143 <br /> STOCKTON, CA 95205 Elk Grove, CA 95624 144, 145, 146 <br /> Contact phone Not Specified 916 837 3293 141 <br /> Contact email mobussar@yahoo.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate calendar year ( ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: AV Date: <br /> ——— — —— - - -- --- — — — — —— — — — — —- <br /> Accounting: Reviewed by: 9` Date: (o/l 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 /> 1920-HMBP-Common Materials 4 chem units PRO527148 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO522503 TIMOTHY ENGLE Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522461 HARPRIT MATTU Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534676 not assigned Inactive [ ] [ ] <br />