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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12126/2014 <br /> Submitted on: 12/23/2014 11:06:14AM CERS ID: 10185387 <br /> Submitted by: Manuel Medeinos Email: manuelmedeinos@yahoo.com Facility ID in CERS: FA0016776 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013617 <br /> Owner name MANUEL MEDEIROS MANUEL MEDEIROS 111 <br /> Mailing address 11776 S AIRPORT WAY 11776 S AIRPORT WAY 113 <br /> MANTECA, CA 95336 MANTECA, CA 95336 114, 115, 11E <br /> Work phone (209) 858-5565 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016776 <br /> Facility name MANUEL MEDEIROS MANUEL MEDEIROS 3 <br /> Site address 11776 S AIRPORT WAY 11776 S AIRPORT WAY 103 <br /> City MANTECA 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 209-858-5565 {209) 858-5565 105 <br /> Facility mailing address 11776 SAIRPORT WAY MANTECA 11776 SAIRPORT WAY 108a <br /> MANTECA, CA 95336 MANTECA, CA 95336 108b, 108c, 108 <br /> BILLING INFORMATION <br /> Contact name MANUEL MEDEIROS MANUEL MEDEIROS 140 <br /> Address 11776 S AIRPORT WAY 11776 S AIRPORT WAY 143 <br /> MANTECA, CA 95336 MANTECA, CA 95336 144, 145, 14( <br /> Contact phone Not Specified (209) 858-5565 141 <br /> Contact email 142 <br /> Mail invoices to Ow;er <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR##: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ J full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: M 1 Date: iZ 126 ] f`1 <br /> Accounting: Reviewed by: Date: l9 t Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ j Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1958-HM-Farm Operations PR0524961 MICHAEL PARISSI Active [ ] [ ] <br /> 2830-AST FAC -SPCC EXEMPT PRO529055 ELENA MANZO Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533226 not assigned Inactive [ ] [ ] <br />