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SAN JOAQUrrv-11"OUNTY ENVIRONMENTAL HEALTF--oEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1f1312015 <br /> Submitted on: 1/11/2015 12:33:03PM CERS ID: 10166969 <br /> Submitted by. Denise Holmes Email: Denise.Holmes@fosterfarms.com Facility ID in CERS: FA0017536 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014377 <br /> Owner name Foster Farms Foster Farms 111 <br /> Mailing address P.O. Box 831 P.O. Box 831 113 <br /> Livingston, CA 95334 Livingston, CA 95334 114, 115, 116 <br /> Work phone 209-394-7901 2093947901 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017536 <br /> Facility name Foster Farms Flood 1 Ranch Foster Farms Flood 1 Ranch 3 <br /> Site address 5999 N Escalon Bellota Rd 5999 N Escalon Bellota Rd 103 <br /> City Linden Linden 104 <br /> ZIP code 95236 95236 105 <br /> Facility phone 209-394-7901 2093947901 102 <br /> Facility mailing address P.O. Box 831 P.O. Box 831 108a <br /> Livingston, CA 95334 Livingston, CA 95334 108b, 108c,losd <br /> BILLING INFORMATION <br /> Contact name Shelley Worsham Denise Holmes 140 <br /> Address P.O. Box 831 P.O. Box 831 143 <br /> Livingston, CA 95334 Livingston, CA 95334 144, 145, 146 <br /> Contact phone 209-394-5352 2093945352 141 <br /> Contact email shelley.worsham@fosterfarms.com denise.holmes@fosterfarms.com 142 <br /> Mail invoices to Qtr <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 this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by: zlt Date: 3110LI Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] 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 PRO525721 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO530156 WILLY NG Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534094 not assigned Inactive [ ] [ ] <br />