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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 7114/2014 <br /> Submitted on: 1/15/2013 5:26:35PM CERS ID: 10186189 <br /> Submitted by: Frank Drake Email: fdrake11@comcast.net Facility ID in CERS: FA0017273 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014114 <br /> Owner name JOHN A DAVIS JOHN A DAVIS 111 <br /> Mailing address 9362 N HILDRETH LN 9362 N HILDRETH LN 113 <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 114, 115, 116 <br /> Work phone 209 931-3012 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017273 <br /> Facility name JOHN A DAVIS JOHN A DAVIS 3 <br /> Site address 11566 E HWY 26 11566 E HWY 26 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 95215 95215 105 <br /> Facility phone 209-931-6390 (209) 931-6390 0 102 <br /> Facility mailing address 9362 N HILDRETH LN 9362 N HILDRETH LN 108a <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 108b,105c,108d <br /> BILLING INFORMATION <br /> Contact name DAVIS, JOHN A DAVIS, JOHN A 140 <br /> Address 9362 N HILDRETH LN 9362 N HILDRETH LN 143 <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 144, 145, 146 <br /> Contact phone Not Specified 209 931-3012 141 <br /> Contact email 142 <br /> Mail invoices to Owner <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 Integratio'nJ Wizard by: Date: <br /> -------------- <br /> Accounting: Reviewed by: Date: 4_,_;� <br /> : Date. <br /> Clerical: [ ] File [ ] Relabel file j ] Create new file <br /> B <br /> r{--]—Aeet-billed— .[�]-S�Irar�e-veraflec�- y <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 PR0525458 not assigned Active I ] ( ] <br /> 2220-SM HW GEN<5 TONSNR PR0530277 JEFFREY WONG Active I ] [ ] <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0530276 JEFFREY WONG Active, Exempt [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PRO534631 not assigned Inactive { ] [ ] <br />