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SAN JOAQUIiv-COUNTY ENVIRONMENTAL HEALTH-oEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6!2412015 <br /> Submitter! on: 6/19/2015 12:15:52PM CERS ID: 10614328 <br /> Submitted by: Jose Valdez Email: lose.valdez6600@broncowine.com Facility ID in CERS: incorrect <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0020812 <br /> Owner name West coast grape farming WEST COAST GRAPE FARMING INC 111 <br /> Mailing address 6342 Bystrum road P.O. BOX 488 113 <br /> Ceres, CA 95307 CERES, CA 95307 114, 115, 116 <br /> Work phone 209-272-3000 209-272-3000 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022853 <br /> Facility name Shady Oaks Ranch Shady Oaks Ranch 3 <br /> Site address 15800 N THORNTON RD 15800 N Thornton Rd 103 <br /> City Jodi lodi 104 <br /> ZIP code 95242 95242 105 <br /> Facility phone 209-272-3000 209-272-3000 102 <br /> Facility mailing address 6342 bystrum road P.O. BOX 488 108a <br /> Ceres, CA 95307 CERES, CA 95307 108b, 1d8c,load <br /> BILLING INFORMATION <br /> Contact name Frank Canela FRANK CANELA 140 <br /> Address 6342 Bystrum Road P.O. BOX 488 143 <br /> Ceres, CA 95307 CERES, CA 95307 144, 145, 146 <br /> Contact phone 209-272-3035 209-272-3035 141 <br /> Contact email frank.canela@broncowine.com frank.canela@broncowine.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP jj SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [�:] APSA [ ] CaIARP [ ] UST New PE: ) cy <br /> Assigned to: k1r0- U e IcS e' <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: S� ` Date: /�'4/45— <br /> Accounting: Reviewed by: Date: �IZS S Clerical: [ ] File ] ] Relabel file [ ] Create new file <br /> Acct billed �'rcharge verified By: Date: <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 PR0539978 ,JAMIE DE lA ROSA Active [ J [ } <br /> a'�3,C <br /> A 31 <br /> �D a83y �� C kS sKfm►�,1+ , <br />