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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/17/2017 <br /> Submitted on: 7/17/2017 11:56:09AM CERS ID: 10181251 <br /> Submitted by: Steven Canepa Email: canepacarwash@att.net Facility ID in CERS: FA0003624 <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: 3 <br /> Owner ID OW0000629 <br /> Owner name Marion Canepa CANEPA 111 <br /> Mailing address 642 N HUNTER ST 6230 PACIFIC AVE 113 <br /> STOCKTON, CA 95202 STOCKTON, CA 95207 114, 115, 116 <br /> Work phone 209-465-6114 209-478-5515 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003624 <br /> Facility name CANEPAS CAR WASH CANEPAS CAR WASH 3 <br /> Site address 6230 PACIFIC AVE 6230 PACIFIC AVE 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-478-5515 (209)478-5515 102 <br /> Facility mailing address 6230 PACIFICAVE 6230 PACIFICAVE 108a <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name CANEPAS CAR WASH CANEPAS CAR WASH 140 <br /> Address 6230 PACIFICAVE 6230 PACIFICAVE 143 <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 144, 145, 146 <br /> Contact phone 209-478-5515 (209)478-5515 141 <br /> Contact email canepacarwash@att.net canepacarwash@att.net 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SCIG 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: 000--1 7 Date: l -k7-17 <br /> ---- - --- - -- -- - - - ------ - --- - ----- -- --- -- - - -- <br /> Accounting: Reviewed by: L'�) Date: -711CI I'I 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 /> 1615-RETAIL MKT 301-2000 SQ FT(PREPKGD/LTD PREP; PR0160903 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location 8 chem units PR0519724 JAMIE LIMA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0521679 VICKI MCCARTNEY Active [ ] [ ] <br /> 2361 -UST FACILITY PR0231225 VICKI MCCARTNEY Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511847 HAZ MAT SJC OES Inactive <br /> 2227-GEN 13<25 TONS PERMIT PR0505916 MICHAEL KITH Inactive [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PR0507720 MICHAEL KITH Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507373 MICHAEL KITH Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534163 not assigned Inactive [ ] [ ] <br /> 6k ne o+ d&� o%er VLkr, ofpAgvek aLs per Se44 c. V'* rpt a j4A ;w L. (� <br />