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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/14/2014 <br /> Submitted on: 9/25/2014 1:25:52PM CERS ID: 10592446 <br /> Submitted by. Kelly Mora Email: kellymora@att.net 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 /> Owner ID OW0009604 <br /> Owner name MCCLELLAND, KELLY Kelly Mclelland Mora 111 <br /> Mailing address PO BOX 31945 p.o box 31945 113 <br /> STOCKTON, CA 95213 stockton, CA 9521331945 114, 115,116 <br /> Work phone 209-943-2186 209-298-2971 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010370 <br /> Facility name PAC TRUCKING PAC Trucking Co. 3 <br /> Site address 1200 N GOLDEN GATE AVE 1200 N Golden Gate Ave 103 <br /> City STOCKTON Stockton 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone 209-943-2186 209-943-2186 102 <br /> Facility mailing address PO BOX 31945 po box 31945 108a <br /> STOCKTON, CA 95213 Stockton, CA 9521331945 108b, 108 , 108d <br /> BILLING INFORMATION <br /> Contact name PAC TRUCKING Kelly Mclelland Mora 140 <br /> Address PO BOX 31945 p.o. box 31945 143 <br /> STOCKTON, CA 95213 stockton, CA 9521331945 144, 145, 146 <br /> Contact phone Not Specified 209-298-2971 141 <br /> Contact email kellymora@att.net 142 <br /> Mail invoices to Ow/ier R <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ J 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 through CERS Integration Wizard by: Date: II-vi-vl <br /> Accounting: Reviewed by:_ Date: �I -1 Clerical: [�"File [ ] Relabel file [ ] Create new file <br /> � ------------------------ <br /> ----------- ---- --- <br /> [ ] A ed [ ] Surch erifiecl ----- By: Date_— <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 2220-SM HW GEN c5 TONSNR PR0514299 STACY RIVERA Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO521228 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510370 HAZ MAT SJC DES Inactive [ ] [ ] <br />