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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/21/2014 <br /> Submifted on: 2/27/2013 10:29:39AM CERS ID: 10181713 <br /> Submitted by: Richard Dawson Email: rick@calwalnut.com Facility ID in CERS: FA0005029 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0003916 <br /> Owner name DWAIN ZACK DWAIN ZACK 111 <br /> Mailing address 27155 TIFFANI LN 21332 McHenryAvenue 113 <br /> ESCALON, CA 95320 ESCALON, CA 95320 114, 115, 116 <br /> Work phone 209 996 8613 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0005029 <br /> Facility name DAWSON RANCH DAWSON RANCH 3 <br /> Site address 21332 S MCHENRYAVE 21332 S MCHENRY AVE 103 <br /> City ESCALON ESCALON 104 <br /> Zip code 95320 95320 105 <br /> Facility phone 209-838-6887 (209) 838-6887 0 102 <br /> Facility mailing address 27155 TIFFANI LN 27153 Tiffani Lane 108a <br /> ESCALON, CA 95320 ESCALON, CA 95320 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name DAWSON RANCH DAWSON RANCH 140 <br /> Address 27155 TIFFANI LN 27153 Tiffani Lane 143 <br /> ESCALON, CA 95320 ESCALON, CA 95320 144, 145, 146 <br /> Contact phone Not Specified 209 838 6887 141 <br /> Contact email J 142 <br /> Mail invoices to 4D wRer- <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: /Q�f� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acc ledSurchar ified Y <br /> 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-Farre Operations PRO525892 not assigned Active [ ] I ] <br /> 2332-EXEMPT TANK FACILITY PRO501224 ALISON YOUNGBLOOD Inactive [ ] ( ] <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529959 WILLY NG Active, Exempt [ ] I ] <br />