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SAN JOAQUIn-A=NTY ENVIRONMENTAL HEALTh- EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/21/2014 <br /> Submitted on: 2/28/2014 11:54:13AM CERS ID: 10181179 <br /> Submitted by: Dana Nissen Email: nissendairyinc@aol.com Facility ID in CERS: FA0003480 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0002600 <br /> Owner name NISSEN DAIRY INC NISSEN DAIRY INC 111 <br /> Mailing address 17283 S BRENNAN RD 17283 S BRENNAN RD 113 <br /> ESCALON, CA 95320 ESCALON, CA 95320 114, 115,116 <br /> Work phone 209-838-2542 (209)639-7618 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003480 <br /> Facility name NISSEN DAIRY INC NISSEN DAIRY INC 3 <br /> Site address 17263 S BRENNAN RD 17263 S BRENNAN RD 103 <br /> City ESCALON ESCALON 104 <br /> Zip code 95320 95320 105 <br /> Facility phone 209-838-2542 (209) 838-2542 102 <br /> Facility mailing address 17283 S BRENNAN RD 17283 S BRENNAN RD 108a <br /> ESCALON, CA 95320 ESCALON, CA 95320 108b,10ac,1084 <br /> BILLING INFORMATION <br /> Contact name NISSEN DAIRY INC NISSEN DAIRY INC 140 <br /> Address 17283 S BRENNAN RD 17283 S BRENNAN RD 143 <br /> ESCALON, CA 95320 ESCALON, CA 95320 144, 145, 146 <br /> Contact phone 209-838-7618 (209)639-7618 141 <br /> Contact email 142 <br /> Mail invoices to Facility✓ <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendarear <br /> � [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: J'`_/ y Date: 1/ <br /> AccountinReviewed b --Date, 9 Clerical: [ ] File [ ] Relabel file [ j Create new file <br /> g: --- <br /> [ ] A — Ile-- [ ] S - geve— -- <br /> rified --- --- --gy: 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 PR0525901 not assigned Active [ ] [ ] <br /> 2011-GRADE A DAIRY PRO200109 NICHOLAS WIESEMAN Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO529182 ELENA MANZO Active [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0529181 MUNIAPPA NAIDU Active, Exempt [ ] [ ] <br />