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SAN JOAQUlktOUNTY ENVIRONMENTAL HEALTH"eEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/25/2014 <br /> Submitted on: 2/13/2014 8:13:16AM CERS ID: 10421899 <br /> Submitted by: Ronn Leffler Email: ARAGONLOR2001@yahoo.com Facility ID in CERS: <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0019888 <br /> Owner name Ronn and Lance Leffler Ronn and Lance Leffler 111 <br /> Mailing address 6488 E Eight Mile Rd 6488 E Eight Mile Rd 113 <br /> Stockton, CA 95212 Stockton, CA 95212 114, 115, 116 <br /> Work phone 209-986-1045 209-986-1045 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022460 <br /> Facility name Andare Bears Ranch, LLC Go Bears Ranch, LLC 3 <br /> Site address 6488 E Eight Mile Rd 6488 E Eight Mile Rd 103 <br /> City Stockton Stockton 104 <br /> Zip code 95212 95212 105 <br /> Facility phone 209-986-1045 209-986-1045 102 <br /> Facility mailing address 6488 E. Eight Mile Rd. 6488 E. Eight Mile Rd. 108a <br /> Stockton, CA 95212 Stockton, CA 95212 108b,10ec,108d <br /> BILLING INFORMATION <br /> Contact name Holly Renfro Holly Renfro 140 <br /> Address 6488 E Eight Mile Rd 6488 E Eight Mile Rd 143 <br /> Stockton, CA 95212 Stockton, CA 95212 144, 145, 146 <br /> Contact phone 209-406-5790 209-406-5790 141 <br /> Contact email andarebears@gmail.com andarebears@gmail.com 142 <br /> Mail invoices to Facility <br /> Program recordHMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA <br /> [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: full calendar year [ ] prorate thiiscr year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: (_ 1, Date_--� <br /> Accounting: Reviewed by:A Date: Clerical: [ ] File [ ] Relabel file [ j Create new file <br /> ����ft Acct billed [ ] Surcharge verified—— ——— <br /> 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 /> 1921 -HMBP-Regular-Primary Location PR0539275 JAMIE DE LA ROSA Active I I I I <br /> ow fm �-Cgwts <br /> 06W ff�-- <br />