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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 5/11/2015 <br /> Submitted on: 511/2015 11:46:21AM CERS ID: 10181429 <br /> Submitted by: Karen Kammerer Email: lib12@softcom.net Facility ID in CERS: FA0003795 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0002818 <br /> Owner name LIBERTY RURAL FIRE DIST Liberty Fire District 111 <br /> Mailing address 24124 N BRUELLA RD 24124 N BRUELLA RD 113 <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 114, 115, 116 <br /> Work phone 209-368-0905 (209) 339-1329 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003795 <br /> Facility name LIBERTY RURAL FIRE DISTRICT LIBERTY RURAL FIRE DISTRICT 3 <br /> Site address 24124 N BRUELLA RD 24124 N BRUELLA RD 103 <br /> City ACAMPO ACAMPO 104 <br /> ZIP code 95220 95220 105 <br /> Facility phone 209-368-0905 (209) 339-1329 102 <br /> Facility mailing address 24124 N BRUELLA RD 24124 North Bruella Road 108a <br /> ACAMPO, CA 95220 Acampo, CA 95220 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name LIBERTY RURAL FIRE DISTRICT Liberty Fire District 140 <br /> Address 24124 N BRUELLA RD 24124 N BRUELLA RD 143 <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 144, 145. 146 <br /> Contact phone Not Specified (209) 339-1329 141 <br /> Contact email lib12@softcom.net 142 <br /> Mail invoices to Facility <br /> Program record [ HMBP [ ] SQG HW [ ] LQG HW [ ] RCRAHW New PR#: f dJ�Gj <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: MAI <br /> '- Z"Wvt.� Assigned to: -�-./r1o'C L-A <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next <br /> calendar year •� `HCl exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by: L6 Date: STs�,S Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> {�.-,—— billedBy: Date: <br /> -- -- — --------- ---- <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<5 TONS/YR PR0513856 ARIS VELOSO Active [ ] [ ] <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATIVE PR0535679 ARIS VELOSO Active [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PR0507697 FATINAH ZAREEF Inactive [ ] [ ] <br /> 2361 -UST FACILITY PR0231528 ARIS VELOSO Inactive <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507470 FATINAH ZAREEF Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534413 not assigned Inactive [ ] [ ] <br /> C(ti,'C'6,A S <br />