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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 11/3/2015 <br /> Submitted on: 10/30/2015 1:19:28PM CERS ID: 10186733 <br /> Submitted by: Garrett Ulmer Email: gulmer@hixco.biz Facility ID in CERS: FA0017958 <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 OW0014754 <br /> Owner name GARRETT ULMER Mike Scott 111 <br /> Mailing address 536 S AURORA ST 536 S AURORA ST 113 <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 114, 115, 116 <br /> Work phone 209-466-6803 209-948-1123 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017958 <br /> Facility name STOCKTON INDUSTRIAL SUPPLY STOCKTON INDUSTRIAL SUPPLY 3 <br /> Site address 957 E CHURCH ST 957 E CHURCH ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95203 95203 105 <br /> Facility phone 209-466-6803 (209)466-6803 0 102 <br /> Facility mailing address 536 S AURORA ST 536 S AURORA ST 108a <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name STOCKTON INDUSTRIAL SUPPLY STOCKTON INDUSTRIAL SUPPLY 140 <br /> Address 536 S AURORA ST 536 S AURORA ST 143 <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 144, 145, 146 <br /> Contact phone Not Specified 206-466-6803 141 <br /> Contact email 142 <br /> Mail invoices to Owner <br /> Program record [ j HMBP [ j SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] 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: 11--i`t`7 <br /> --------------�—/�.—� __________ <br /> Accounting: Reviewed by: 145 Date: 1/ 3 !-S Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ j Surcharge verified— 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 PR0526517 ROBERT LOPEZ Active [ ] [ <br /> 2220-SM HW GEN<5 TONSNR PR0538596 STACY RIVERA Active [ ] [ <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533214 not assigned Inactive [ ] [ <br />