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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/9/2014 <br /> Submitted on: 12/3/2014 2:01:50PM <br /> 0187591 <br /> Submitted by: Oralia Jimenez Email: onovineyards@aol.com CERS ID: FA0020 <br /> Facility ID in CERS: FA002035555 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0016713 <br /> Owner name O&O JIMENEZ FARM O&O JIMENEZ FARM <br /> Mailing address 22355 N HWY 99 22355 N HWY 99 111 <br /> ACAMPO, CA 9522011 153 <br /> ACAMPO, CA 95220 114, 1 11 <br /> Work phone <br /> (209) 333-1572 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0020355 <br /> Facility name O&O JIMENEZ FARM O&O JIMENEZ FARM 3 <br /> Site address 22355 N HWY 99 22355 N HWY 99 103 <br /> City ACAMPO 104 <br /> ZIP code 95220 95220 105 <br /> Facility phone 209-333-1572 (209) 333-1572 102 <br /> Facility mailing address 22355 N HWY 99 ACAMPO 22355 N HWY 99 108a <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 108b,108c,toe <br /> BILLING INFORMATION <br /> Contact name O&O JIMENEZ FARM O&O JIMENEZ FARM 140 <br /> Address 22355 N HWY 99 22355 N HWY 99 143 <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 144, 145, 14( <br /> Contact phone Not Specified (209)333-1572 141 <br /> Contact email 142 <br /> Mail invoices to 9ww/a <br /> Program record [ ] HMBP [iQ SQG HW [ ] LQG HW [ ] RCRA HW New PR#: 6S3 466 9 <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: _ Z220 <br /> Assigned to: Vr,lD«, <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ j exempt from billing <br /> Processed through CERS Integration Wizard by: /VT Date: 2-1 G )/,I <br /> -t._ <br /> Accounting: Reviewed by Date: Clerical: [ File [ ] Relabel file [ ] Create new file <br /> [ ] Ac ed —�Urchar le 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 PRO535240 not assigned Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0535264 not assigned Inactive [ ] [ ] <br />