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ti <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/2/2017 <br />Submitted on: 6/1/2017 12:53:32PM CERS ID: 10718107 <br />Submitted by: David Blohm Email: dblohm@gsbridge.com Facility ID in CERS: FA0023772 <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner : 1 <br />OW0022108 <br />Golden State Bridge Inc. <br />3701 Mallard Drive <br />Benicia, CA 94510 <br />925-372-8000 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023772 <br />Facility name <br />Golden State Bridge Stockton Yard <br />Site address <br />321 Lipes Dr <br />City <br />Stockton <br />ZIP code <br />95205 <br />Facility phone <br />925-372-8000 <br />Facility mailing address <br />3701 Mallard Drive <br />321 Lipes Dr <br />Benicia, CA 94510 <br />BILLING INFORMATION <br />104 <br />Contact name <br />Stefany Russell <br />Address <br />3701 Mallard Drive <br />3701 Mallard Drive <br />Benicia, CA 94510 <br />Contact phone <br />925-037-2800 <br />Contact email <br />srussell@gebridge.com <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />Golden State Bridge Inc. 111 <br />3701 Mallard Drive 113 <br />Benicia, CA 94510 114, 115, 116 <br />(925)372-8000 112 <br />Golden State Bridge Stockton Yard <br />3 <br />321 Lipes Dr <br />103 <br />Stockton <br />104 <br />95205 <br />105 <br />(925)372-8000 <br />102 <br />3701 Mallard Drive <br />108a <br />Benicia, CA 94510 <br />108b, ioac, 108d <br />Stefany Russell <br />140 <br />3701 Mallard Drive <br />143 <br />Benicia, CA 94510 <br />144, 145, 146 <br />(9250372-8000 <br />141 <br />srussell@gebridge.com <br />142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />New PE: _ <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ]/ next calendar year [ ] exempt from billing <br />'5 <br />Processed through CERS Integration Wizard by: 05r— C7-- y <br />Date:—7'-1-7 <br />-------------------------------------------- <br />Accounting: Reviewed by: Date: 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 Inactiv d <br />1921 - HMBP-Regular-Primary Location 4 chem units PR0541466 ROBERT LOPEZ Active [ ] <br />2239 - REMOTE WASTE CONSOLIDATION SITE PR0541484v THREE VACANT3 Active [ ] <br />