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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 8/13/2018 Submitted on: 2/5/2018 10:59:03AM CERS ID: 10181929 Submitted by: Alfredo Ramirez Email: mtshed@lassencanyonnursery.com Facility ID in CERS: FA0005777 Information prior to CIW processing Information after CIW processing CERS OWNER INFORMATION (current EC database) (current submittal) field Number of Facilities for this Owner : 1 Owner ID OW0004591 Owner name LASSEN CANYON NURSERY LASSEN CANYON NURSERY 111 Mailing address PO BOX 992400 PO BOX 992400 113 REDDING, CA 96099-2400 REDDING, CA 96099-2400 114, 115, 116 Work phone 530-223-1075 5302231075 112 FACILITY FILE INFORMATION Facility ID FA0005777 Facility name LASSEN CANYON NURSERY LASSEN CANYON NURSERY 3 Site address 2955 E Palm Ave 2955 E Palm Ave 103 City Manteca Manteca 104 ZIP code 95337 95337 105 Facility phone 530-223-1075 (530) 223-1075 0 102 Facility mailing address PO BOX 992400 PO BOX 992400 108a REDDING, CA 96099-2400 REDDING, CA 96099-2400 108b, 108c, 108d BILLING INFORMATION Contact name LASSEN CANYON NURSERY LASSEN CANYON NURSERY 140 Address PO BOX 992400 1300 SALMON CREEK RD 143 REDDING, CA 96099 REDDING, CA 96003 144, 145, 146 Contact phone 530-223-1075 5302231075 141 Contact email susie@lassencanyonnursery.com susie@lassencanyonnursery.com 142 Mail invoices to Account Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing _ I �_ 1 � Processed through CERS Integration Wizard b Date: ----------------------------------------- Accounting: Reviewed by: I//3 Date: gllq-ll & Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] Acct billed [ ] Surcharge verified By: Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Record ID Employee name Status Reactivated Inactivated 1920 - HMBP-Common Materials 5 chem units PR0524131 NICHOLAS LOEHRER Active [ ] [ ] 2830 - AST FAC - SPCC EXEMPT PR0539999 TWO VACANT2 Inactive [ ] [ ] ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0534502 not assigned Inactive [ ] [ ]