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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 3/17/2015 <br /> Submitted on: 1/14/2015 9:46:45AM CERS ID: 10185981 <br /> Submitted by: Peter Costamagna Email: cwines3l@yahoo.com Facility ID in CERS: FA0017154 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013995 <br /> Owner name JEM RANCH INC JEM Inc. 111 <br /> Mailing address 2951 W SARGENT RD 2951 W SARGENT RD 113 <br /> LODI, CA 95242 Lodi, CA 95242 114, 115,116 <br /> Work phone 2094034430 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017154 <br /> Facility name JEM RANCH INC JEM RANCH INC 3 <br /> Site address 2951 W SARGENT RD 2951 W SARGENT RD 103 <br /> City LODI LODI 104 <br /> ZIP code 95242 95242 105 <br /> Facility phone 209-369-1640 2093275933 <br /> 102 <br /> Facility mailing address 2951 W SARGENT RD 17046 N DeVries Rd 108a <br /> LODI, CA 95242 Lodi, CA 95242 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name JEM RANCH INC P&L Costamagna 140 <br /> Address 2951 W SARGENT RD 17046 N DeVries Rd 143 <br /> LODI, CA 95242 Lodi, CA 95242 144, 145, 146 <br /> Contact phone Not Specified 2093346728 141 <br /> Contact email cwines3l @yahoo.com 142 <br /> Mail invoices to Owner <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendarear <br /> y [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Jr 1 Date: 3/1-7/15 <br /> Accounting: Reviewed by:y .�Date: 31,E I I) Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ---------------------------- <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 PRO525339 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2830-AST FAC -SPCC EXEMPT PR0529575 ARIS VELOSO Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533150 not assigned Inactive [ ] [ ] <br />