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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/26/2014 <br /> Submitted on: 11/24/2014 3:40:55PM CERS ID: 10186563 <br /> Submitted by: Ken Etherington Email: kenetherington@yahoo.com <br /> Facility ID in CERS: FA0017509 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014350 <br /> Owner name ETHERINGTON ORCHARDS ETHERINGTON ORCHARDS 111 <br /> Mailing address 18401 S CARROLTON RD 2716 Miranda Ave 113 <br /> RIPON, CA 95366 Alamo, CA 94507 114, 115, 11e <br /> Work phone 5105797700 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017509 <br /> Facility name ETHERINGTON ORCHARDS ETHERINGTON ORCHARDS 3 <br /> Site address 18401 S CARROLTON RD 18401 S CARROLTON RD 103 <br /> City RIPON RIPON 104 <br /> ZIP code 95366 95366 105 <br /> Facility phone 209-838-2411 5105797700 102 <br /> Facility mailing address 18401 S CARROLTON RD 2716 Miranda Ave. 108a <br /> RIPON, CA 95366 Alamo, CA 94507 108b,108c,10e <br /> BILLING INFORMATION <br /> Contact name LENOX ETHERINGTON Ken Etherington 140 <br /> Address 18401 S CARROLTON AVE 2716 Miranda Ave 143 <br /> RIPON, CA 95366 Alamo, CA 94507 144, 145, 14f <br /> Contact phone Not Specified 5105797700 141 <br /> Contact email kenetherington@yahoo.com 142 <br /> Mail invoices to Owner A <br /> Program record [ ] HMBP [ ] SQG HW [ ] 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: 1IV-I Date: I1 l r. j rvl <br /> Accounting: Reviewed by:_ � Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Ac illed [ ] Surchar erlfied "` 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 PRO525694 not assigned Active [ ] [ ] <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0529262 WILLY NG Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534678 not assigned Inactive [ ] [ ] <br />