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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 12/15/201E <br />Submitted on: 12/7/2016 3:59:46PM CERS ID: 10186341 <br />Submitted by: Tim McKinsey Email: mckinseyt@me.com Facility ID in CERS: FA0017368 <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner : 1 <br />OW0014209 <br />TIM MCKINSEY <br />11991 HIDDEN GLEN CT <br />OAKDALE, CA 95361 <br />209-996-3314 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0017368 <br />Facility name <br />TIM MCKINSEY <br />Site address <br />30545 E RIVER RD <br />City <br />ESCALON <br />ZIP code <br />95320 <br />Facility phone <br />209-996-3314 <br />Facility mailing address 11991 HIDDEN GLEN CT <br />OAKDALE, CA 95361 <br />BILLING INFORMATION <br />Contact name <br />Address <br />Contact phone <br />Contact email <br />Mail invoices to <br />TIM MCKINSEY <br />11991 HIDDEN GLEN CT <br />OAKDALE, CA 95361 <br />Not Specified <br />Mckinseyt@me.com <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />TIM MCKINSEY 111 <br />PO BOX 863 113 <br />KNIGHTS FERRY, CA 95361 114, 115, 116 <br />209-996-3314 112 <br />TIM MCKINSEY <br />3 <br />30545 E RIVER RD <br />103 <br />ESCALON <br />104 <br />95320 <br />105 <br />(209) 996-3314 0 <br />102 <br />PO BOX 863 <br />108a <br />KNIGHTS FERRY, CA 95361 <br />108b, 108c, 108d <br />TIM MCKINSEY 140 <br />PO BOX 863 143 <br />KNIGHTS FERRY, CA 95361 144, 145, 146 <br />209-996-3314 141 <br />Mckinseyt@me.com 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this alendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: <br />Accounting: Reviewed by: VI'✓ Date: I`II (O'�(( Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1958 - HM -Farm Operations 1 chem units PRO525553 MUNIAPPA NAIDU Active [ ] [ ] <br />2840 - AST EXEMPT FAC < 1,320 GAL PR0529811 WILLY NG Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PRO531832 not assigned Inactive [ ] [ ] <br />