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SAN JOAQUAtOUNTY ENVIRONMENTAL HEALTH PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/6/2015 <br /> Submitted on: 6/30/2015 11:36:08AM CERS ID: 10635316 <br /> Submitted by: Kimberly Williamson Email: tgoffice@aol.com 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 OW0002252 <br /> Owner name Sierra Golf Management Tracy Golf&Country Club 111 <br /> Mailing address 35200 South Chrisman Rd. 35200 S Chrisman Rd 113 <br /> Tracy, CA 95377 Tracy, CA 95377 114, 115,116 <br /> Work phone 559-665-4320 2098359320 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003299 <br /> Facility name Sierra Golf Management Tracy Golf And Country Club 3 <br /> Site address 35200 S CHRISMAN RD 35200 S Chrisman Rd 103 <br /> City Tracy Tracy 104 <br /> ZIP code 95377 95377 105 <br /> Facility phone 209-406-1895 2098359320 102 <br /> Facility mailing address 35200 S. Chrisman Rd. 35200 S. Chrisman Rd 108a <br /> Tracy, CA 95377 Tracy, CA 95377 toeb,toec,wed <br /> BILLING INFORMATION <br /> Contact name Sierra Golf Management Tracy Golf&Country Club 140 <br /> Address PO Box 788 35200 S Chrisman Rd 143 <br /> Chowchilla, CA 93610 Tracy, CA 95377 144, 145, 146 <br /> Contact phone 559-665-4320 2098359320 141 <br /> Contact email tgoffice@aol.com 142 <br /> Mail invoices to Account <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: [ ] full calendar year [ ] prorate <br /> `this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: `^^"' Date: 1' ko' t <- <br /> -------------------------------------------------- <br /> Accounting: Reviewed by: Date: g 3 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ 1 Acct blllArt [ ] c rcharga-vadfied By: Date: <br /> -------------------------------------------------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1621 -BAR w/o FOOD PREP PRO161479 MELISSA NISSIM Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0521160 MICHAEL PARISSI Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO539005 THUY TRAN Active [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO505718 FATINAH ZAREEF Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510170 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 3699-POOUSPA-OUT OF SERVICE PR0360620 JEFFREYWONG Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO532458 not assigned Inactive [ ] [ ] <br />