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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/27/2014 <br /> Submitted on: 5/30/2013 10:17:28AM CERS ID: 10181167 <br /> Submitted by: JOY SEIFERT Email: rrjseifert@aol.com Facility ID in CERS: FA0003459 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0002580 <br /> Owner name SEIFERT, ROBERT& JOY ANN SEIFERT, ROBERT&JOY ANN 111 <br /> Mailing address 8505 E COLLIER RD 8505 E COLLIER RD 113 <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 114, 115,116 <br /> Work phone (209) 810-3434 <br /> 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003459 <br /> Facility name SEIFERT DAIRY LP SEIFERT DAIRY LP 3 <br /> Site address 8505 E COLLIER RD 8505 E COLLIER RD 103 <br /> City ACAMPO ACAMPO 104 <br /> Zip code 95220 95220 <br /> 105 <br /> Facility phone 209-334-4314 (209) 334-4314 102 <br /> Facility mailing address 8505 E COLLIER RD 8505 E COLLIER RD 108a <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 108b,108c,load <br /> BILLING INFORMATION <br /> Contact name SEIFERT DAIRY LP SEIFERT DAIRY LP 140 <br /> Address 8505 E COLLIER RD 8505E COLLIER RD 143 <br /> ACAMPO, CA 95220 A 95220 144, 145, 146 <br /> Contact phone 209-368-0287 209 334-431 141 <br /> Contact email rr]set a aol.com 142 <br /> Mai] invoices to Facility j <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:�Date: (9 O <br /> Accounting: Reviewed by: _ �Date: B//7//Y Clerical: �] File [ ] Relabel file [ ] Create new file <br /> — -- [ ] Ac I led [ ] Surcha v�erZifi`e`dB : Date: <br /> -----�——— ——— -----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 PRO525769 not assigned Active [ ] [ ] <br /> 2011 -GRADE A DAIRY PR0200121 KADEANNE LINHARES Active [ ] [ ] <br /> 2221 -USED OIL ONLY-<5 TONSNR PRO538458 ARIS VELOSO Active [ ] [ ] <br /> 2333-FARM UST#1 FACILITY-obsolete PRO503109 Fatina Zareef Inactive [ ] [ ] <br /> 2775-EMPLOYEE HOUSING-DAIRY EXEMPTION PRO516801 ROBIN TRINDADE Inactive [ ] [ ] <br /> 2830-AST FAC -SPCC EXEMPT PR0529326 ARIS VELOSO Active,Exempt [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523681 TED TASIOPOULOS Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531344 not assigned Inactive [ ] [ ] <br />