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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/7/2014 <br /> Submitted on: 11/4/2014 11:19:49AM CERS ID: 10181359 <br /> Submitted by: Balaji Angle Email: lindabkeny@gmail.com Facility ID in CERS: FA0003732 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0002012 <br /> Owner name ANGLE, BALAJI & CHHAYA ANGLE, BALAJI & CHHAYA 111 <br /> Mailing address 7700 MORELAND ST 35584 CONOVAN LN 113 <br /> STOCKTON, CA 95212 FREMONT, CA 94536 114, 115.116 <br /> Work phone 510-792-8151 (510)552-4822 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003732 <br /> Facility name 99 SHELL* 99 SHELL* 3 <br /> Site address 7700 MORELAND ST 7700 MORELAND ST 103 <br /> City Stockton STOCKTON 104 <br /> ZIP code 95212 95212 105 <br /> Facility phone 209-957-5398 (209)957-5398 <br /> 102 <br /> Facility mailing address 7700 MORELAND CT 35584 CONOVAN LN 108a <br /> STOCKTON, CA 95212 FREMONT, CA 94536 108b, 1080,108d <br /> BILLING INFORMATION <br /> Contact name 99 SHELL* ANGLE, BALAJI&CHHAYA 140 <br /> Address 7700 MORELAND ST 35584 CONOVAN LN 143 <br /> STOCKTON, CA 95212 FREMONT, CA 94536 144. 145. 146 <br /> Contact phone 123-456-7890 (510)552-4822 141 <br /> Contact email 142 <br /> Mail invoices to F#Ity PA <br /> Program record [ ] HMBP [ ] SQG HW [ j LQG HW ( ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ j prorate this calendar year [ ] next calendarear <br /> y [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by: Date: Clerical: `J>Q File Relabel file <br /> ----- C <br /> [ ] [ ] Create new file <br /> [ ] Ac d [ ] Surc I led By: Date: <br /> ———— ------ [ --- <br /> --------------------------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1615-RETAIL MKT 301-2000 SQ FT(PREPKGD/LTD PREP; PRO162338 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1920-HMBP-Common Materials PRO520841 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO618092 FATINAH ZAREEF Active [ ] [ ] <br /> 2351 -UST FACILITY-2481 COMPLIANT PR0231819 FATINAH ZAREEF Active [ ] [ ] <br /> 2221 -USED OIL ONLY-<5 TONS/YR PRO516661 THUY TRAN Inactive [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PR0507689 FATINAH ZAREEF Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507425 FATINAH ZAREEF Inactive [ ] [ ] <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0526393 FATINAH ZAREEF Inactive [ ] [ ] <br /> 3123-STORMWATER INSPECTION-RETAIL GAS OUTLET PR0523004 GARRETT BACKUS Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532073 not assigned Inactive [ ] [ ] <br />