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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/26/2014 <br /> Submitted on: 12/22/2014 12:08:21PM CERS ID: 10487242 <br /> Submitted by: Dana R Crum Email: dana.crum@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 OW0020062 <br /> Owner name Dana R. Crum Dana R. Crum 111 <br /> Mailing address 16504 Henry Rd 16504 Henry Rd 113 <br /> Escalon, CA 95320 Escalon, CA 95320 114, 115, 11E <br /> Work phone 209-838-2118 209-838-2118 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022527 <br /> Facility name Crum Family Ranch LLC Crum Family Ranch LLC 3 <br /> Site address 16504 Henry Rd 16504 Henry Rd 103 <br /> City Escalon 104 <br /> ZIP code 95320 95320 105 <br /> Facility phone 209-838-2118 209-838-2118 102 <br /> Facility mailing address 16504 Henry Rd Escalon 16504 Henry Rd 108a <br /> Escalon, CA 95320 Escalon, CA 95320 108b,108c,10E <br /> BILLING INFORMATION <br /> Contact name Crum Family Ranch LLC Crum Family Ranch LLC 140 <br /> Address 16504 Henry Rd 16504 Henry Rd 143 <br /> Escalon, CA 95320 Escalon, CA 95320 144, 145, 14E <br /> Contact phone 209-838-2118 209-838-2118 141 <br /> Contact email dana.crum@yahoo.com sjhawley@sbcglobal.net 142 <br /> Mail invoices to Fasility// <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 [ j exempt from billing <br /> Processed through CERS Integration Wizard by: P,I i Date: ;Z L +; <br /> Accounting: Reviewed by: Date: 1243ojj 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 /> 1956-HM-Farm Operations PR0539414 MICHAEL PARISSI Active I I I I <br />