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SAN JOAOUI OUNTY ENVIRONMENTAL HEALT PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 3/19/2015 <br /> Submitted on: 1/23/2015 4:33:43PM CERS [D: 10183233 <br /> Submitted by: Dwanna Berkenbile Email: clf4580@comcast.net Facility ID in CERS: FA0010119 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0008119 <br /> Owner name Dean Berkenbile Dean Berkenbile 111 <br /> Mailing address 4580 S HWY 99 4580 S HWY 99 113 <br /> STOCKTON, CA 95215-8220 STOCKTON, CA 95215 114, 115, 116 <br /> Work phone 209-465-9131 2094659131 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010119 <br /> Facility name CALIFORNIA LIVE FLOORS INC CALIFORNIA LIVE FLOORS INC 3 <br /> Site address 4580 S HWY 99 4580 S HWY 99 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95215-8220 95215-8220 105 <br /> Facility phone 209-465-9131 2094659131 102 <br /> Facility mailing address 4580 S Hwy 99 4580 S Hwy 99 108a <br /> Stockton, CA 95215-8235 Stockton, CA 95215-8235 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name California Live Floors,lnc. California Live Floors,lnc. 140 <br /> Address 4580 S HWY 99 4580 S HWY 99 143 <br /> STOCKTON, CA 95215-8220 STOCKTON, CA 95215 144, 145, 146 <br /> Contact phone 209-465-9131 2094659131 141 <br /> Contact email clf4580@comcast.net calivefloors@yahoo.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] 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: I Date: <br /> Accounting: Reviewed by: t6 Date: Z�I I i Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> -— -— [ ] A -- filled_ [ ] Surch_ a 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 /> 1921 -HMBP-Regular-Primary Location PRO520082 JAMIE DE LA ROSA Active [ ] t ] <br /> 2220-SM HW GEN <5 TONS/YR PR0514178 STACY RIVERA Inactive <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510119 HAZ MAT SJC OES Inactive [ I [ 1 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531533 not assigned Inactive [ � [ <br />