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SAN JOAQUI.n000NTY ENVIRONMENTAL HEALTHMMMARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 3/12/2015 <br /> Submitted on: 1/15/2015 5:55:25PM CERS ID: 10185911 <br /> Submitted by: Doug Carruesco Email: pramorino@carescohomes.com Facility]Din CERS: FA0017109 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013950 <br /> Owner name RICHARD CARRUESCO RICHARD CARRUESCO 111 <br /> Mailing address 9837 N ALPINE RD 9837 N ALPINE RD 113 <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 114, 115, 116 <br /> Work phone (209) 952-6733 <br /> 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017109 <br /> Facility name RICHARD CARRUESCO RICHARD CARRUESCO 3 <br /> Site address 9837 N ALPINE RD 9837 N ALPINE RD 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95212 95212 105 <br /> Facility phone 209-931-3984 (209)952-6733 102 <br /> Facility mailing address 9837 N ALPINE RD 9837 N ALPINE RD 108a <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name RICHARD CARRUESCO Doug Carruesco 140 <br /> Address 9837 N ALPINE RD 3350 Deer Park Drive, Suite C 143 <br /> STOCKTON, CA 95212 STOCKTON, CA 95219 144, 145, 146 <br /> Contact phone Not Specified (209)952-6733 141 <br /> Contact email ✓ pramorino@carescohomes.com 142 <br /> Mail invoices to i r' <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 calendar year ( ] exempt from billing <br /> Processed through CERS Integration Wizard by: %y"1 Date: 3 1-2— 15 <br /> Accounting: Reviewed by: Date: �VY / 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 PR0525294 _ HAZA SAEED Active [ ] [ <br /> 2830-AST FAC -SPCC EXEMPT _ - PR0529013 FATINAH ZAREEF Active [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531998 not assigned Inactive [ ] [ ] <br />