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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 2/15/2017 <br />Submitted on: 2/15/2017 9:00:13AM <br />Submitted by: John Inderbitzin Email: inderbitzinjohn@comcast.net <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 />OW0013611 <br />JOHN INDERBITZIN <br />13742 S AUSTIN RD <br />MANTECA, CA 95336 <br />209-823-3016 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0016770 <br />Facility name <br />JOHN INDERBITZIN <br />Site address <br />13730 S AUSTIN RD <br />City <br />MANTECA <br />ZIP code <br />95336 <br />Facility phone <br />209-823-3016 <br />Facility mailing address <br />13742 S AUSTIN RD <br />MANTECA, CA 95336 <br />BILLING INFORMATION <br />Contact name <br />JOHN INDERBITZIN <br />Address <br />13742 S AUSTIN RD <br />MANTECA, CA 95336 <br />Contact phone <br />209-823-3016 <br />Contact email <br />Mail invoices to <br />Account <br />CERS ID: 10185379 <br />Facility ID in CERS: FA0016770 <br />Information after CIW processing CERS <br />(current submittal) field <br />JOHN INDERBITZIN 111 <br />13742 S AUSTIN RD 113 <br />MANTECA, CA 95336 114, 115, 116 <br />(209) 823-3016 112 <br />JOHN INDERBITZIN <br />3 <br />13730 S AUSTIN RD <br />103 <br />MANTECA <br />104 <br />95336 <br />105 <br />(209) 823-3016 <br />102 <br />13742 S AUSTIN RD <br />108a <br />MANTECA, CA 95336 <br />108b, 108c, 108d <br />JOHN INDERBITZIN 140 <br />13742 S AUSTIN RD 143 <br />MANTECA, CA 95336 144, 145, 146 <br />(209) 823-3016 141 <br />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 calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: ,�J: J Date: <br />Accounting: Reviewed by: � Date: v/2`f / 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 PR0524955 MUNIAPPA NAIDU Active <br />2840 - AST EXEMPT FAC < 1,320 GAL PR0529039 MUNIAPPA NAIDU Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0534389 not assigned Inactive [ ] [ ] <br />N o <br />l �I 2,0 <br />