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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 11/14/2014 <br /> Submitted on: 11/13/2014 11:55:58AM CERS ID: 10181453 <br /> Submitted by: Steve Kinoshita Email: skinoshita@chp.ca.gov <br /> Facility ID in CERS: FA0003825 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> (current EC database) (current submittal) field <br /> OWNER INFORMATION <br /> Owner ID OW0002750 111 <br /> ifornia Highway Patrol <br /> Owner name DEPARTMENT OF CALIFORNIA HIGHWAY Cal113 <br /> Mailing address PO BOX 942898 P.O. Box 942898 114, 115, 11E <br /> SACRAMENTO, CA 94298-0001 Sacramento, CA 94298 112 <br /> Work phone 916-843-3800 (916) 843-3800 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003825 FORNIA <br /> Facility name CALIFORNIA HIGHWAY PATROL#265` 3CAL330[ N AD ART RD 104 PATROL#265' 103 <br /> Site address 3330 N AD ART RD 3330 N AD 104 <br /> City Stockton 105 <br /> ZIP code 95215 95215 <br /> Facility phone 209-943-8666 (209)943-8666 102 <br /> Facility mailing address 3330 N Ad Art Road 3330 N.Ad Art Rd. 108a <br /> Stockton, CA 95215 Stockton, CA 95215 108b,108c,10e <br /> BILLING INFORMATION <br /> Contact name Department of California Highway Patrol California Highway Patrol 140 <br /> 143 <br /> Address PO BOX 942898 P.O. Box 942898 <br /> SACRAMENTO, CA 94298-0001 Sacramento, CA 94298 144, 145, 14E <br /> Contact phone 916-843-3540 (916) 843-3800 141 <br /> Contact emailedepaola@chp.ca.gov 142 <br /> Mail invoices to F m+ty 14 <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed tIV( gh CERS Integration Wizard by: n( I Date: h i ]-i )!-] <br /> Accounting: Reviewed by: X_Date: 7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Afg t-bltled [ ] Surcha ee fieri By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials PR0519593 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0519194 FATINAH ZAREEF Active [ ] [ ] <br /> 2361 -UST FACILITY PR0231901 FATINAH ZAREEF Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0523797 ALFONSOARAMBULA Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507484 LETITIA BRIGGS Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532442 not assigned Inactive [ ] [ ] <br />