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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 2/5/2015 <br /> Submitted on: 1/16/2015 2:23:31PM CERS ID: 10185277 <br /> Submitted by: Vicky Kootstra Email: Pacificag r@sbcglobal,net Facility ]Din CERS: FA0016711 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013552 <br /> Owner name PACIFIC AGRILANDS INC Rolling Hills Ranch LLC 111 <br /> Mailing address 5206 HAMMETT RD 5206 HAMMETT RD 113 <br /> MODESTO, CA 95358 MODESTO, CA 95358 114, 115, 116 <br /> Work phone 209-545-1623 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016711 <br /> Facility name PACIFIC AGRILANDS INC PACIFIC AGRILANDS INC 3 <br /> Site address 19380 E HARNEY LN 19380 E HARNEY LN 103 <br /> City LODI LODI 104 <br /> ZIP code 952409742 95240-9742 105 <br /> Facility phone 209-531-4180 (209) 531-4180 0 102 <br /> Facility mailing address 5206 HAMMETT RD 5206 HAMMETT RD 108a <br /> MODESTO, CA 95358 MODESTO, CA 95358 108b, 1080, load <br /> BILLING INFORMATION <br /> Contact name PACIFIC AGRILANDS INC PACIFIC AGRILANDS INC 140 <br /> Address 5206 HAMMETT RD 5206 HAMMETT RD 143 <br /> MODESTO, CA 95358 MODESTO, CA 95358 144, 145, 146 <br /> Contact phone Not Specified 209-545-1623 141 <br /> Contact email <br /> 142 <br /> Mail invoices to <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] 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: 9 ` Date: <br /> -- ---------------------- <br /> Accounting: Reviewed by: Date: .311 L f 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 /> 1958-HM-Farm Operations PR0524896 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0529285 ARIS VELOSO Active [ ] [ ] <br /> 2830-AST FAC -SPCC EXEMPT PR0529284 ARIS VELOSO Active [ ] ( ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533336 not assigned Inactive [ ] ( ] <br />