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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/29/2016 <br /> Submitted on: 11/28/2016 2:04:16PM CERS ID: 10181543 <br /> Submitted by: marc marceron Email: marc.marceron@usw.salvationarmy.org Facility ID in CERS: FA0003949 <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: 3 <br /> Owner ID OW0000324 <br /> Owner name The Salvation Army The Salvation Army 111 <br /> Mailing address 180 E. Ocean Blvd 3rd Floor 180 E. Ocean Blvd 3rd Floor 113 <br /> Long Beach, CA 90802 Long Beach, CA 90802 114, 115, 116 <br /> Work phone 562-491-4100 (562)491-4100 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003949 <br /> Facility name SALVATION ARMY ADULT REHAB SALVATION ARMY ADULT REHAB 3 <br /> Site address 1247 S WILSON WAY 1247 S WILSON WAY 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone 209-466-3871 (209) 466-3871 0 102 <br /> Facility mailing address 1247 S WILSON WAY 1247 S WILSON WAY 108a <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 108b, 108c, load <br /> BILLING INFORMATION <br /> Contact name Desiree Razon Desiree Razon 140 <br /> Address 1247 S Wilson Way 1247 S Wilson Way 143 <br /> Stockton, CA 95205 Stockton, CA 95205 144, 145, 146 <br /> Contact phone 209-466-3871 (209)466-3871 141 <br /> Contact email desiree.razon@usw.salvationarmy.org desiree.razon@usw.salvationarmy.org 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP SQG HW [ ] LOG HW [ ] RCRA HW New PR#: [H <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: 2ZZ0 <br /> Assigned to::1MM1 4 rAo <br /> Please bill: [ ] full calendar year [ ] prorateth�ear [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: l qyl 1110 <br /> Accounting: Reviewed by: 6*42 Date: 113O/tL,3O/tClerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> - - - --- -- -------- - - - -- - -- - <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 PR0519680 HAZA SAEED Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO538027 HARPRIT MATTU Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511780 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231298 LETITIA BRIGGS Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509492 HAZ MAT SJC DES Inactive [ ] [ J <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534732 not assigned Inactive [ ] [ ] <br />