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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 1/14/2015 <br /> Submitted on: 12/29/2014 3:39:14PM CERS ID: 10422622 <br /> Submitted by: Dustin Wagner Email: wagnerdairylp@yahoo.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 OW0019892 <br /> Owner name Dustin Wagner Dustin Wagner 111 <br /> Mailing address 22176 Skiff Rd. 22176 Skiff Rd. 113 <br /> Escalon, Ca 95320 Escalon, CA 95320 114, 115, 116 <br /> Work phone 209-652-5192 209-652-5192 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022462 <br /> Facility name Lazy G Ranch Lazy G Ranch 3 <br /> Site address 5624 E Highway 4 5624 E Highway 4 103 <br /> City Farmington Farmington 104 <br /> ZIP code 95230 95230 105 <br /> Facility phone 209-838-7547 209-838-7547 102 <br /> Facility mailing address 22176 Skiff Rd. 22176 Skiff Rd. 108a <br /> Escalon, Ca 95320 Escalon, CA 95320 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name Dustin Wagner Dustin Wagner 140 <br /> Address 22176 Skiff Rd. 22176 Skiff Rd. 143 <br /> Escalon, CA 96320 Escalon, CA 96320 144, 145, 146 <br /> Contact phone 209-652-5192 209-652-5192 141 <br /> Contact email wagnerdairylp@yahoo.com wagnerdairylp@yahoo.com 142 <br /> Mail invoices to Facility <br /> Program record HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: VLOS Y111` l <br /> 13 <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: ) at 5% <br /> Assigned to: 9*19ASS1 <br /> Please bill: full calendar year [ ] prorate <br /> ''this <br /> __(calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: �Jl/1`� Date: (•1`{•\9!( <br /> ---------------' �—' ------ --- <br /> Accounting: Reviewed by: Date: I ------------------------ <br /> IZV S Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified 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 /> not assigned <br />