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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/26/2016 <br />Submitted on: 1/25/2016 12:02:53PM <br />Submitted by: Jenn Bartlett Email: JBartlett@erminc.com <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 : 2 <br />OW0020211 <br />Edward R. Marszal Enterprises, Inc. <br />P:.O. Box 1096 <br />Carmichael, CA 95609 <br />916-488-3666 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0003834 <br />Facility name <br />Pacific Avenue Chevron <br />Site address <br />6633 PACIFIC AVE <br />City <br />Stockton <br />ZIP code <br />95207 <br />Facility phone <br />209-477-4294 <br />Facility mailing address <br />P.O. Box 1096 <br />FATINAH ZAREEF <br />Carmichael, CA 95609 <br />BILLING INFORMATION <br />PR0507699 <br />Contact name <br />Cassandra Hamm <br />Address <br />P.O. Box 1096 <br />MICHAEL KITH <br />Carmichael, CA 95609 <br />Contact phone <br />916-488-3666 <br />Contact email <br />CHamm@erminc.com <br />Mail invoices to <br />Account <br />CERS ID: 10594654 <br />Facility ID in CERS: FA0003834 <br />Information after CIW processing CERS <br />(current submittal) field <br />Edward R. Marszal Enterprises, Inc. 111 <br />5805 Windmill Way 113 <br />Carmichael, CA 95608 114, 115, 116 <br />916-488-3666 112 <br />Pacific Avenue Chevron 3 <br />6633 Pacific Avenue 103 <br />Stockton 104 <br />95207 105 <br />209-477-4294 102 <br />5805 Windmill Way 108a <br />Carmichael, CA 95608 108b, 108c, 108d <br />Cassandra Hamm <br />140 <br />5805 Windmill Way <br />143 <br />Carmichael, CA 95608 <br />144, 145, 146 <br />916-488-3666 <br />141 <br />CHamm@erminc.com <br />142 <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 [ ] proratethi calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: - �-6'� io <br />Accounting: Reviewed by: Date: 1 �2(P Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Proqram Element and Description <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location <br />PR0520539 <br />HAZA SAEED <br />Active [ ] [ ] <br />2220 - SM HW GEN <5 TONS/YR <br />PR0514447 <br />FATINAH ZAREEF <br />Active <br />2361 - UST FACILITY <br />PR0231784 <br />FATINAH ZAREEF <br />Active (] [ ] <br />2301 - UST STATE SURCHARGE FEE <br />PR0507699 <br />MICHAEL KITH <br />Inactive [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PR0507491 <br />MICHAEL KITH <br />Inactive [ ] ( ] <br />3123 - STORMWATER INSPECTION - RETAIL GAS OUTLET <br />PR0523006 <br />GARRETT BACKUS <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0534207 <br />not assigned <br />Inactive [ ] [ ] <br />