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SAN JOAQUIFv.,,OUNTY ENVIRONMENTAL HEALTH cPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1112412015 <br /> Submitted on: 11/21/2015 11:11:40AM CERS 'ID: 10417348 <br /> Submitted by: Brent Boersma Email: brentboersma@gmail.com Facility ID in. CERS: FA0003581 <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 OW0002687 <br /> Owner name Brent Boersma Brent Boersma 111 <br /> Mailing address 15326 E. Hwy 120 15326 E. Hwy 120 113 <br /> Ripon, CA 95366 Ripon, CA 95366 114, 115, 116 <br /> Work phone 209-599-3470 209-599-3470 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003581 <br /> Facility name Boersma Farms, LP Boersma Farms, LP 3 <br /> Site address 15326 E HWY 120 15326 E. Hwy 120 103 <br /> City Ripon Ripon 104 <br /> ZIP code 95366 95366 105 <br /> Facility phone 209-599-3470 209-550-1597 102 <br /> Facility mailing address 15326 E. Hwy 120 15326 E. Hwy 120 108a <br /> Ripon, CA 95366 Ripon, CA 95366 108b, 108c,Igsd <br /> BILLING INFORMATION <br /> Contact name Boersma Farms, LP Brent Boersma 140 <br /> Address 15326 E. Hwy 120 15326 E. Hwy 120 143 <br /> Ripon, CA 95366 Ripon, CA 95366 144, 145, 146 <br /> Contact phone 209-550-1597 209-550-1597 141 <br /> Contact email brentboersma@gmail.com brentboersma@gmail.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW ( ] RCRA HW New PR#: <br /> created ( ] Tiered permit D4 APSA [ ] CaIARP [ ] UST New PE: <br /> 3 Assigned to: e�rZ� <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 /> Accounting: Reviewed by: t16 Date: I i 12-S!15 Clerical [ ] 'File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record 1D Employee name Status Reactivated Inactivated <br /> 2220-SM HW GEN <5 TONS/YR PR0539237 ELENA MANZO Active [ ] [ l <br /> 2333-EXCLUDED UST FACILITY PR0234059 ALISON YOUNGELOOD Inactive [ ] [ ] <br /> ddb 3d Pie S I <br />