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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/2/2015 <br /> Submitted on: 10/28/2015 4:02:02PM CERS ID: 10184203 <br /> Submitted by: Mlke Brandt Email: sjc8081@sbcglobal.net Facility ID in CERS: FA0012370 <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 OW0009597 <br /> Owner name BRANDT, MICHAEL BRANDT, MICHAEL 111 <br /> Mailing address 910 BLACK DIAMOND WAY 910 BLACK DIAMOND WAY 113 <br /> LODI, CA 95240 LODI, CA 95240 114, 115, 116 <br /> Work phone 209-365-9694 209-365-9694 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012370 <br /> Facility name SAN JOAQUIN CHROME SAN JOAQUIN CHROME 3 <br /> Site address 916 BLACK DIAMOND WAY STE A 916 BLACK DIAMOND WAY STE A 103 <br /> City LODI LODI 104 <br /> ZIP code 95240 95240 105 <br /> Facility phone 209-365-9694 (209) 365-9694 102 <br /> Facility mailing address 910 BLACK DIAMOND WAY 910 BLACK DIAMOND WAY 108a <br /> LODI, CA 95240 LODI, CA 95240 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name SAN JOAQUIN CHROME SAN JOAQUIN CHROME 140 <br /> Address 910 BLACK DIAMOND WAY 910 BLACK DIAMOND WAY 143 <br /> LODI, CA 95240 LODI, CA 95240 144, 145, 146 <br /> Contact phone 209-365-9694 209-365-9694 141 <br /> Contact email 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: SH JAS <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 2 22 D <br /> Assigned to: 1� <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [.,(next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: V"f j Date: l 1. 1 1 <br /> ------------------ -------------------------------- <br /> Accountin . Reviewed by: J Date: I I/-3 I S� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ I-AcctbWad r 1 c rcharge 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 /> 1925-HMBP-Multisite Secondary Location PR0520939 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0515900 SITE UNASSIGNED Inactive [ ] [ ] <br />