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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/19/2017 <br />Submitted on: 3/10/2017 9:09:20AM CERS ID: 10483849 <br />Submitted by: Richard Teicheira Email: richardteicheira@comcast.net Facility ID in CERS: FA0016691 <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 />OW0013532 <br />Richard Teicheira <br />715 Poplar Ave <br />Manteca, CA 95336 <br />209-239-9581 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0016691 <br />Facility name <br />Escalon Ranch <br />Site address <br />13742 Carrolton Rd <br />City <br />Escalon <br />ZIP code <br />95320 <br />Facility phone <br />209-239-9581 <br />Facility mailing address <br />715 Poplar Ave <br />Manteca, CA 95336 <br />BILLING INFORMATION <br />Contact name <br />Richard Teicheira <br />Address <br />715 Poplar Ave <br />Manteca, CA 95336 <br />Contact phone <br />209-239-9581 <br />Contact email <br />richardteicheira@comcast.net <br />Mail invoices to <br />Owner <br />Information after CIW processing CERS <br />(current submittal) field <br />Richard Teicheira 111 <br />715 Poplar Ave 113 <br />Manteca, CA 95336 114, 115, 116 <br />209-239-9581 112 <br />Escalon Ranch 3 <br />13742 Carrolton Rd 103 <br />Escalon 104 <br />95320 105 <br />209-239-9581 102 <br />715 Poplar Ave 108a <br />Manteca, CA 95336 108b, 108c, 1o8d <br />Richard Teicheira 140 <br />715 Poplar Ave 143 <br />Manteca, CA 95336 144, 145, 146 <br />209-239-9581 141 <br />richardteicheira@comcast.net 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 [ ] proratethiscalendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: ,/0'� �-- Date: <br />------------------------------- <br />Accounting: Reviewed by: Lb Date: 4l iq 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 />Record ID Employee name Status Reactivated Inactiv ed <br />1958 - HM -Farm Operations 1 chem units PR0524876 MUNIAPPA NAIDU Active [ ] <br />2840 - AST EXEMPT FAC < 1,320 GAL PR0529247 WILLY NG Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0531744 not assigned Inactive [ ] [ ] <br />it <br />pig S� J wr V14� <br />