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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/23/2014 <br /> Submitted on: 2/11/2013 8:09:18PM CERS ID: 10182061 <br /> Submitted by: Patrick Visser Email: visserpat@gmail.com Facility ID in CERS: FA0006254 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) — current submittal) field <br /> Owner ID OW0004983 <br /> Owner name VISSAR, JOSEPH Patrick Visser 111 <br /> Mailing address 25326 S FREDRICK 25200 S FREDERICK AVE 113 <br /> Work hone RIPON, CA 95366 IPON, CA 95366 114, 115,116 <br /> p 2 93074 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006254 <br /> Facility name VISSER FARM VISSER FARM 3 <br /> Site address 25200 S FREDERICK AVE 25200 S FREDERICK AVE 103 <br /> City RIPON RIPON 104 <br /> Zip code 95366 95366 105 <br /> Facility phone 209-599-3074 (209) 599-3074 0 102 <br /> Facility mailing address 25326 S FREDRICK 25326 S FREDRICK 108a <br /> RIPON, CA 95366 RIPON, CA 95366 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name VISSER FARM VISSER FARM 140 <br /> Address 25326 S FREDRICK 25326 S FREDRICK 143 <br /> RIPON, CA 95366 RIPON, CA 95366 144, 145. 146 <br /> Contact phone Not Specified 2095993074 141 <br /> Contact email 142 <br /> Mail invoices to -Owner-A/ e I/Program record [ ] HMBP [ ] SQG HW [ I LOG 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: Date: <br /> -------------- <br /> ------- -------- - --- - - <br /> Accounting: Reviewed by: Date:� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Ac illed [ ] Surc 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 PR0525948 not assigned Active [ ] [ ] <br /> 2332-EXEMPT TANK FACILITY PRO504593 ALISON YOUNGBLOOD Inactive [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO530166 WILLY NG Active,Exempt [ ] [ ] <br />