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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 3/6/2018 <br /> Submitted on: 12/11/2017 3:19:27PM CERS ID: 10749769 <br /> Submitted by: Kareemah Montano Email: kareemahq@live.com Facility ID in CERS: incorrect <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: 1 <br /> Owner ID OW0022892 <br /> Owner name MONTANO, KAREEMAH KAREEMAH MONTANO 111 <br /> Mailing address 2650 WIGWAM DR UNITA 2136 REPORT AVE 113 <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 114, 115, 116 <br /> Work phone 2096394803 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0024344 <br /> Facility name FAIRWAY AUTOMOTIVE REPAIR FAIRWAY AUTOMOTIVE REPAIR 3 <br /> Site address 2650 WIGWAM DR UNITA 2650 Wigwam Dr Unit 103 <br /> City STOCKTON Stockton 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone 209-942-2915 2099422915 102 <br /> Facility mailing address 2650 WIGWAM DR UNITA 2650 WIGWAM DR UNITA 108a <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name FAIRWAY AUTOMOTIVE REPAIR KAREEMAH MONTANO 140 <br /> Address 2650 WIGWAM DR UNITA 2650 Wigwam Dr Unit 143 <br /> STOCKTON, CA 95205 Stockton, CA 95205 144, 145, 146 <br /> Contact phone 209-942-2915 2096394803 141 <br /> Contact email 142 <br /> Mail invoices to W,IN <br /> Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PRM PRO 542603 <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 2��0 <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [2] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: (1v— Date: <br /> -------------------------------------------------- <br /> Accounting: Reviewed by:_Jf5 Date: 3 I g Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [,.}Acct billed [,4-Surcharge verified Air &]ua By: Date: <br /> -- - - --- — <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials 2 chem units PR0542374 ROBERT LOPEZ Active I I I I <br /> Lre®,l,j- <br />