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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 5/11/2017 <br />Submitted on: 5/1/2017 8:52:12AM <br />Submitted by: Scott Baker Email: sbaker@cvagtransport.com <br />CERS ID: 10666546 <br />Facility ID in CERS: FA0023377 <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />104 <br />Number of Facilities for this Owner : 1 <br />95203 <br />105 <br />Owner ID <br />OW0021605 <br />102 <br />Facility mailing address 5707 Langworth Road <br />Owner name <br />Mike Barry and Paul Konzen <br />Mike Barry and Paul Konzen <br />111 <br />Mailing address <br />5707 Langworth Road Paul Konze <br />5707 Langworth Road Paul Konze 113 <br />Oakdale, CA 95361 <br />Oakdale, CA 95361 <br />114, 115, 116 <br />Work phone <br />209-495-8777 <br />209-495-8777 - Mike <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID FA0023377 <br />Facility name Central Valley Ag Grinding Stockton Facility <br />Central Valley Ag Grinding Stockton Facility 3 <br />Site address 26 Hooper St <br />26 Hooper St <br />103 <br />City Stockton <br />Stockton <br />104 <br />ZIP code 95203 <br />95203 <br />105 <br />Facility phone 209-232-3582 <br />209-232-3582 <br />102 <br />Facility mailing address 5707 Langworth Road <br />5707 Langworth Road <br />108a <br />Oakdale, CA 95361 <br />Oakdale, CA 95361 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name CENTRAL VALLEY AG GRIDING STKN FA( <br />Ryan Hogan <br />140 <br />Address 5707 Langworth Road <br />5707 Langworth Road <br />143 <br />Oakdale, CA 95361 <br />Oakdale, CA 95361 <br />144, 145, 146 <br />Contact phone 209-232-3566 <br />209-232-3566 <br />141 <br />Contact email rhogan@cvaggrinding.com <br />rhogan@cvaggrinding.com <br />142 <br />Mail invoices to Account <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ <br />] RCRA HW New PR#: <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ <br />] UST New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate calendar year <br />[ ] next calendar year [ <br />] exempt from billing <br />nthis <br />- <br />Processed through CERS Integration Wizard by: '0✓"` Ic')— Date: <br />5-A-Q <br />Accounting: Reviewed by: � Date: S1/S�/ Clerical: [ ] File [ ] Relabel <br />file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified <br />By: <br />Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status <br />Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location 2 chem units PR0540880 ROBERT LOPEZ Active <br />[] [] <br />