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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/9/2015 <br /> Submitted on: 3/23/2015 9:27:54AM CERS ID: 10184817 <br /> Submitted by: Mark Valadez Email: mvaladez@masonite.com Facility ID in CERS: FA0014889 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0011895 <br /> Owner name ENGLANDER TUALATIN SLEEP PRODU Masonite Corporation 111 <br /> Mailing address PO BOX 605 One Tampa City Center-201 N. Franklin ! 113 <br /> TUALATIN, OR 97062 Tampa, FL 33602 114, 115, 116 <br /> Work phone 209-983-9181 (800) 895-2723 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014889 <br /> Facility name ENGLANDER TUALATIN SLEEP PRODUC' EN ECI�c11D R TUALATIN SLEEP PRODUC' 3 <br /> Site address 3632 PETERSEN RD#150 3632 PETERSEN RD#150 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95215 95215 105 <br /> Facility phone 209-983-9181 (209) 942-5626 102 <br /> Facility mailing address PO BOX 605 3632 Petersen Rd. Suite 200 108a <br /> TUALATIN, OR 97062 Stockton, CA 95215 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name ENGLANDER TUALATIN SLEEP PRODUC' Masonite Corporation 140 <br /> Address PO BOX 605 3632 Petersen Rd. 143 <br /> TUALATIN, OR 97062 Stockton, CA 92015 144, 145, 146 <br /> Contact phone Not Specified (209) 942-5626 141 <br /> Contact email druhstaller@masonite.com 142 <br /> Mail invoices to Owner <br /> Program record [ ] HMBP SCG HW [ ] LQG HW [ ] RCRA HW New PR#: 9 rj'I <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 2'7-20 <br /> Assigned to: 11.rCII-lY <br /> Please bill: full calendar year [ ] prorate this,calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: Lt •9• t S <br /> ------------ - -------------------- --------------- ---- <br /> Accounting: Reviewed by: ( _Date: 'y 1241/S Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [Acct billed [>q 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 /> 1920-HMBP-Common Materials PR0521905 ROBERT LOPEZ Inactivej- [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO536305 HAZ MAT SJC OES Inactive <br />