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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 3/23/2015 <br /> Submitted on: 1/29/2015 3:39:47PM CERS ID: 10185445 <br /> Submitted by: Dustin Wagner Email: wagnerdairylp@yahoo.com Facility ID in CERS: FA0016809 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013650 <br /> Owner name Richard Wagner Richard Wagner 111 <br /> Mailing address 22176 SKIFF RD 22176 SKIFF RD 113 <br /> ESCALON, CA 95320 ESCALON, CA 95320 114, 115, 116 <br /> Work phone 209-652-5099 (209) 652-5099 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016809 <br /> Facility name CARTER RANCH FEEDLOT Carter Ranch Feedlot 3 <br /> Site address 25801 CARTER RD 25801 CARTER RD 103 <br /> City ESCALON ESCALON 104 <br /> ZIP code 95320 95320 105 <br /> Facility phone 209-838-7547 (209) 838-7547 <br /> 102 <br /> Facility mailing address 22176 SKIFF RD 22176 SKIFF RD 108a <br /> ESCALON, CA 95320 ESCALON, CA 95320 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name CARTER RANCH FEEDLOT WAGNER DAIRY L.P. 140 <br /> Address 22176 SKIFF RD 22176 SKIFF RD 143 <br /> ESCALON, CA 95320 ESCALON, CA 95320 144, 145, 146 <br /> Contact phone 209-838-7547 (209)838-7547 141 <br /> Contact email wagnerdairylp@yahoo.com wagnerdairylp@yahoo.com 142 <br /> Mail invoices to Account <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 Integration Wizard by: A" Date: 3'Z3 15 <br /> ----------------------------------------------- ---- <br /> Accounting: Reviewed by: Date: 3 7`1II S Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> -------------------------------------------------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1958-HM-Farre Operations PRO524994 MICHAEL PARISSI Active [ ] [ ] <br /> 2830-AST FAC -SPCC EXEMPT PRO530548 STACY RIVERA Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531309 not assigned Inactive [ ] [ ] <br />