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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/2512014 <br /> Submitted on: 11/21/2094 5:45:42PM <br /> CERS ID; 101$5383 <br /> Submitted by: Don Putz Email: dwputzd@verizon.net <br /> Facility ID in CERS: FA0016773 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013614 <br /> Owner name LAZY P RANCHES LAZY P RANCHES 111 <br /> Marling address 11441 JAMESON RD 11441 E. JAMESON RD 113 <br /> MANTECA, CA 95336 MANTECA, CA 95336 114, 115, 11E <br /> Work phone 209-239-6369 (209) 239-6369 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016773 <br /> Facility name LAZY P RANCHES LAZY P RANCHES 3 <br /> Site address 11441 JAMESON RD 11441 JAMESON RD 103 <br /> City MANTECA MANTECA 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 209-239-6369 (209) 239-6369 0 102 <br /> Facility mailing address 11441 JAMESON RD 11441 E. JAMESON RD 108a <br /> MANTECA, CA 95336 MANTECA, CA 95336 108b,108c, 10E <br /> BILLING INFORMATION <br /> Contact name LAZY P RANCHES LAZY P RANCHES 140 <br /> Address 11441 JAMESON RD 11441 E. JAMESON RD 143 <br /> MANTECA, CA 95336-8748 MANTECA, CA 95336-8748 144, 145, 14E <br /> Contact phone 209-239-6369 209-239-6369 141 <br /> Contact email dwputzd@verizon.net dwputzd@verizon.net 142 <br /> Mail invoices to Qwnw <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: Date: <br /> Accounting: Reviewed by: ,Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct ed Surch veri lef�. B 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 PR0524958 not assigned Active [ ] [ } <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532440 not assigned Inactive [ ] [ ] <br />