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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 9/22/2016 <br /> Submitted on: 9/15/2016 1:05:51 PM CERS ID: 10184857 <br /> Submitted by: Ramon Mata Email: ramon@pacificboatservices.com Facility ID in CERS: FA0015065 <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: 2 <br /> Owner ID OW0016825 <br /> Owner name MATA, RAMON MATA, RAMON 111 <br /> Mailing address 8090 RIO BLANCO RD ramon@pacificboatservices.com 113 <br /> STOCKTON, CA 95219 LODI, CA 95242 114, 115, 116 <br /> Work phone 209-334-2127 2093342127 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015065 <br /> Facility name PACIFIC BOAT SERVICES PACIFIC BOAT SERVICES 3 <br /> Site address 8090 N RIO BLANCO RD 8090 N RIO BLANCO RD 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95219 95219 105 <br /> Facility phone 209-334-2127 (209)334-2127 102 <br /> Facility mailing address 8090 N RIO BLANCO RD 8090 Rio Blanco Rd#A 108a <br /> STOCKTON, CA 95219 Stockton, CA 95219 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name PACIFIC BOAT SERVICES PACIFIC BOAT SERVICES 140 <br /> Address 8090 N RIO BLANCO RD 8090 N RIO BLANCO RD#A 143 <br /> STOCKTON, CA 95219 STOCKTON, CA 95219 144, 145, 146 <br /> Contact phone Not Specified 209-334-2127 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ]gnext calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: `M Date: <br /> ------9. -----y-- ------ -- --------------------- <br /> Accountin Reviewed b : t6 Date: 9�"1/Le • Clerical: [ ] File [ ] Relabel fjJe [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: —__ Date_ <br /> -------------------------------------- ----- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Pro ram Element and Description Record ID Emolovee name Status Reactivated Inactivated <br /> 21 -HMBP-Regular-Primary Location PR0541266 HAZA SAEED Active I I [ 1 <br /> 2220-SM HW GEN<5 TONSNR PR0522105 ARIS VELOSO Active [ ] [ 1 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO532195 not assigned Inactive [ ] [ ] <br /> L,eT4 bQ9\rle35 6L rl,ie- 4-0 r�s«6�,�f 004 Pfa ,;d9 <br /> Ma,I'A5 0,jj"es3 poo RVI ewvt I I adclre5E. <br />