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SAN JOAQUh. COUNTY ENVIRONMENTAL HEALTh vEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/212015 <br /> Submitted on: 12/1112014 12:53:30PM CERS ID: 10183759 <br /> Submitted by: Debbie Livermore Email: debbie.livermore@stocktongov.com Facility ID in CERS: FA0010681 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0008643 <br /> Owner name CITY OF STOCKTON- MUD CITY OF STOCKTON- MUD 111 <br /> Mailing address 2500 NAVY DR 2500 NAVY DR 113 <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 114, 115, 116 <br /> Work phone 209-937-8700 209-937-8700 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010681 <br /> Facility name STKN MUD WELLS#SSS-4 STKN MUD WELLS#SSS-4 3 <br /> Site address 7200 S LONGE ST 7200 S LONGE ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95206 95206 105 <br /> Facility phone 209-937-8246 (209) 937-8246 102 <br /> Facility mailing address 2500 NAVY DRIVE 2500 NAVY DRIVE 108a <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 108b,10ec,1 08 <br /> BILLING INFORMATION <br /> Contact name CITY OF STOCKTON- MUD CITY OF STOCKTON- MUD 140 <br /> Address 2500 NAVY DR 2500 NAVY DR 143 <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 144, 145, 146 <br /> Contact phone 209-937-8700 209-937-8700 141 <br /> Contact email 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ j Tiered permit [ ] APSA [ ] CalARP [ j UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate <br /> +this <br /> �[calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: VAN Date: - <br /> Accounting: Reviewed by: J Date: [ �V !s Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inabfivated <br /> 1926-HMBP-Unstaffed Network Location PRO512969 ROBERT LOPEZ Active [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510681 HAZ MAT SJC OES Inactive <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO528499 MUNIAPPA NAIDU Inactive [ j I <br />