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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 CERS ID: 10185379 <br /> Submitted by: John Inderbitzin Email: inderbitzinjohn@comcast.net Facility ID in CERS: FA0016770 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0013611 <br /> Owner name JOHN INDERBITZIN JOHN INDERBITZIN 111 <br /> Mailing address 13742 S AUSTIN RD 13742 S AUSTIN RD 113 <br /> MANTECA, CA 95336 MANTECA, CA 95336 114, 115, 116 <br /> Work phone 209-823-3016 (209) 823-3016 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016770 <br /> Facility name JOHN INDERBITZIN JOHN INDERBITZIN 3 <br /> Site address 13730 SAUSTIN RD 13730 SAUSTIN RD 103 <br /> City MANTECA MANTECA 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 209-823-3016 (209) 823-3016 102 <br /> Facility mailing address 13742 S AUSTIN RD 13742 S AUSTIN RD 108a <br /> MANTECA, CA 95336 MANTECA, CA 95336 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name JOHN INDERBITZIN JOHN INDERBITZIN 140 <br /> Address 13742 SAUSTIN RD 13742 SAUSTI N RD 143 <br /> MANTECA, CA 95336 MANTECA, CA 95336 144, 145, 146 <br /> Contact phone 209-823-3016 (209) 823-3016 141 <br /> Contact email 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] 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: ,,�1Date: <br /> Accounting: Reviewed by: � Date: 149'h 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 Inactivated <br /> 1958-HM-Farm Operations 1 chem units PR0524955 MUNIAPPA NAIDU Active [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO529039 MUNIAPPA NAIDU Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534389 not assigned Inactive <br /> CITVIA I,rvo�cA 1N� was xscw.mrh'� <br /> � rJ `2- <br /> Vq � <br />