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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1!7/2015 <br /> Submitted on: 1/5/2015 2:19:54PM CERS ID: 10185329 <br /> Submitted by: william elsholz Email: williamelsholz@att.net Facility ID in CERS: FA0016739 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013580 <br /> Owner name WILLIAM ELSHOLZ WILLIAM ELSHOLZ 111 <br /> Mailing address 20656 N KENNEFICK RD 20656 N KENNEFICK RD 113 <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 114, 115, 11E <br /> Work phone 209-368-0435 2093680435 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016739 <br /> Facility name WILLIAM ELSHOLZ WILLIAM ELSHOLZ 3 <br /> Site address 20656 N KENNEFICK RD 20656 N KENNEFICK RD 103 <br /> City ACAMPO 104 <br /> ZIP code 95220 95220 105 <br /> Facility phone 209-368-0435 (209) 327-2193 102 <br /> Facility mailing address 20656 N KENNEFICK RD ACAMPO 20656 N KENNEFICK RD 108a <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 108b,108c,10e <br /> BILLING INFORMATION <br /> Contact name WILLIAM ELSHOLZ WILLIAM ELSHOLZ 140 <br /> Address 20656 N KENNEFICK RD 20656 N KENNEFICK RD 143 <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 144, 145, 14f <br /> Contact phone 209-368-0435 2093680435 141 <br /> Contact email 142 <br /> Mail invoices to 9wrter <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: /V7 Date: 17/15- <br /> Accounting: Reviewed by: tt3 Date: //9//- Clerical: [ ] File [ ] Relabel file <br /> [ ] 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 PRO524924 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO530442 WILLY NG Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532109 not assigned Inactive [ ] [ ] <br />