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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/14/2016 <br /> Submitted on: 6/6/2016 11:42:47AM CERS ID: 10646167 <br /> Submitted by: litzel mantilla Finail: litzel–mancilla@yahoo.com Facility ID in CERS: FA0021888 <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 OW0018025 <br /> Owner name MANCILLA, LITZEL Litzel Mantilla 111 <br /> Mailing address 22212 MARIPOSA RD 4208 E. Main St. 113 <br /> ESCALON, CA 95320 Stockton, CA 95215 114: 115, 116 <br /> Work phone 209-809-6574 (209) 872-9049 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021888 <br /> Facility name CHAVEZ TIRES CHAVEZ TIRES 3 <br /> Site address 4208 E MAIN ST 4208 E Main St 103 <br /> City STOCKTON Stockton 104 <br /> ZIP code 95215 95215 105 <br /> Facility phone 209-809-6574 (209) 809-6574 102 <br /> Facility mailing address 4208 E MAIN ST 4208 E. Main St. 1082 <br /> STOCKTON, CA 95215 Stockton, CA 95215 10eb, 108c,Toed <br /> BILLING INFORMATION <br /> Contact name CHAVEZ TIRES Litzel Mantilla 140 <br /> Address 4208 E MAIN ST 4208 E. Main St. 143 <br /> STOCKTON, CA 95205 Stockton, CA 95215 144, 145v 146 <br /> Contact phone 209-809-6574 (209) 872-9049 141 <br /> Contact email 142 <br /> Mail invoices to �F—`t' <br /> Program record [ J HMBP [ ] SOG 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 this calendar year [ ]' next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: Oat 14 f t , <br /> Accounting: Reviewed by: �� Date: tr Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 2228-SM HW GEN<5 TONSIYR PR0540356 CINDY VO Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0537920 ANGELICA SANDOVAL MA' Active [ ] [ ] <br /> 1920-HMBP-Common Materials PRO540357 NICHOLAS LOEHRER Inactive [ ] [ ] <br />