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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/21/2014 <br /> Submitted on: 3/28/2014 6:44:12PM CERS ID: 10181299 <br /> Submitted by: thien phan Email calstop209@gmail eom Facility ID in CERS: FA0003679 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0002747 <br /> Owner name PHAN, NHUAN T & PHAN, DUNG T PHAN, NHUAN T 111 <br /> Mailing address 2.224 S MANTHEY RD 2224 S MANTHEY RD 113 <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 114, 115, 116 <br /> Work phone 209-462-7621 2097637785 112 <br /> FACILITY FILE INFORMATION <br /> Facility I D FA0003679 <br /> Facility name CALIFORNIA STOP' CALIFORNIA STOP* 3 <br /> Site address 2224 MANTHEY RD 2224 MANTHEY RD 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 95206 95206 105 <br /> Facility phone 209-462-7621 (209) 462-7621 102 <br /> Facility mailing address 2224 S MANTHEY RD 2224 S MANTHEY RD 108a <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 rasa,108c,load <br /> BILLING INFORMATION <br /> Contact name CALIFORNIA STOP* CALIFORNIA STOP' 140 <br /> Address 2224 S MANTHEY RD 2224 S MANTHEY RD 143 <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 144, 145, 146 <br /> Contact phone Not Specified 2094627621 141 <br /> Contact email CALSTOP209@GMAIL.COM 142 <br /> Mail invoices to Facility- <br /> Program record [ ] HMBP j ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit j ] 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: (0 <br /> — ------ - --- -- <br /> Accounting: Reviewed by: Date: iedO <br /> Clerical: File [ ] Relabel file [ ] Create new file <br /> Surc t e vB Date: <br /> AeCbllled [ ] gy <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials PR0520905 ROBERTLOPEZ Active { ] [ ] <br /> 2220-SM HW GEN <5 TONSIYR PRO521586 THUY TRAN Active [ ] [ ] <br /> 2361 -UST FACILITY PR0232555 THUY TRAN Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507397 STEVE SASSON Inactive [ ] [ ] <br />