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SAN JOAQUi. .,JUNTY ENVIRONMENTAL HEALTi..JCPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 7/22/2014 <br />Submitted on: 3/1/2013 12:50:04PM CERS ID: 10202383 <br />Submitted by: Satara Henry Email: satara.henry@pscnow.com Facility ID in CERS: <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 />OW0011441 <br />MCCOY TRUCK TIRE SERV CTR INC <br />1407 LONE PALM AVE <br />MODESTO, CA 95351 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0014399 <br />Facility name <br />MCCOY TRUCK TIRE SERVICE CENTER I <br />Site address <br />10850 S HARLAN RD <br />City <br />FRENCH CAMP <br />Zip code <br />95231 <br />Facility phone <br />209-982-0115 <br />Facility mailing address <br />10850 S HARLAN RD <br />FRENCH CAMP, CA 95231 <br />BILLING INFORMATION <br />Information after CIW processing <br />(current submittal) <br />PSC Industrial Outsourcing LP <br />5151 San Felipe Ste.1600 <br />Houston, TX 77056 <br />713-858-0768 <br />CERS <br />field <br />111 <br />113 <br />114, 115, 116 <br />112 <br />PCS Industrial Outsourcing French Camp 3 <br />10850 S Harlan Rd 103 <br />French Camp 104 <br />95231 105 <br />800-321-1030 102 <br />10850 S.Harlan Road <br />French Camp, CA 95231 <br />Contact name MCCOY TRUCK TIRE SERV CTR INC Brent Lowe <br />Address 1407 LONE PALM AVE 1802 Shelton Drive <br />MODESTO, CA 95351 Hollister, CA 95023 <br />Contact phone Not Specified 408-761-3612 <br />Contact email brent.lowe@pscnow.com <br />Mail invoices to Owner <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 />108a <br />108b, 108c, 108d <br />140 <br />143 <br />144, 145, 146 <br />141 <br />142 <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: <br />----------------------------------------------------- <br />Accounting: Reviewed by: _ % Date:Clerical: [�%] File [Relabel file [ ] Create new file <br />Surch ie-� /� : Date: <br />[] Acc � ed []� veri __ B Y <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 PR0519257 HAZ MAT SJC OES Inactive [ ] [ ] <br />4740 - WASTE TIRE SITE - EXEMPT PR0523739 ALFONSO ARAMBLILA Active [ ] [ ] <br />