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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/22/201 <br /> Submitted on: 12/2/2014 12:48:09PM CERS ID: 10183261 <br /> Submitted by: charles patel Email: cpatel209@aol.com Facility ID in CERS: FA0010146 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0008146 <br /> Owner name PATEL, CHANDRAKANT B"CHARLES' PATEL, CHANDRAKANT B "CHARLES' 111 <br /> Mailing address 4850 BRIDGEWATER CIR 3395 willowbrook CIR 113 <br /> STOCKTON, CA 95219 STOCKTON, CA 95219 114, 115, 116 <br /> Work phone 209-477-4321 (209) 477-4321 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010146 <br /> Facility name C&S ONE HOUR MARTINIZING C&S ONE HOUR MARTINIZING 3 <br /> Site address 5756 PACIFIC AVE 5756 PACIFIC AVE STE 1 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-477-4321 (209)477-4321 <br /> 102 <br /> Facility mailing address 5756 PACIFIC AVE STE#1 5756 PACIFIC AVE STE#1 108a <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 108b,108c,10ad <br /> BILLING INFORMATION <br /> Contact name C&S ONE HOUR MARTINIZING C&S ONE HOUR MARTINIZING 140 <br /> Address 5756 PACIFIC AVE#1 5756 PACIFIC AVE#1 143 <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 144, 145, 146 <br /> Contact phone 209-477-4321 (209)477-4321 141 <br /> Contact emailcpatel209@aol.com 142 <br /> Mail invoices to FZ P <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA <br /> [ J 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: VA Date: 1 �"}Z•\`'� <br /> ------------------------------- —J--------- - - -- <br /> Accounting: Reviewed by:_�Date: ) `�/5 Clerical: [)Q File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified --!J By: Date: <br /> ----------------------- - - <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMBP-Regular-Primary Location PR052 0098 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PRO514199 FATINAH ZAREEF Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510146 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533207 not assigned Inactive [ ] [ ] <br />