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SAN JOAQUIITJUNTY ENVIRONMENTAL HEALTH �ir=_PARTMENT <br /> !VI <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/14/201.4 <br /> Submitted on: 1/23/2013 12:33:25PM CERS ID: 10186199 <br /> Submitted by: Tim Sunbury Email: TSunbury@verizon.net Facility ID in CERS: FA0017279 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014120 <br /> Owner name .S K RANCH (SHATTO) Shatto Vnyd 111 <br /> Mailing address PO BOX 15; 11878 Ave 328 113 <br /> FARMINGTON, CA 95230° Visalia, CA 93291 114, 115,116 <br /> Work phone 209 8865493 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017279 <br /> Facility name S K RANCH (SHATTO) Shatto vnyd 3 <br /> Site address S COPPEROPOLIS 18190 Copperopolis Rd 103 <br /> City LINDEN Linden 104 <br /> Zip code 95236 95236 105 <br /> Facility phone 209-886-5493 5596251114 102 <br /> Facility mailing address PO BOX 15 PO Box 190 108a <br /> FARMINGTON, CA 95230 Farmington, CA 95230 108b,108C,1o8d <br /> BILLING INFORMATION <br /> Contact name S K RANCH (SHATTO) Shatto Vnyd' 140 <br /> Address PO BOX 15 PO Box 190 143 <br /> FARMINGTON, CA 95230 Farmington, CA 95230 144, 145, 146 <br /> Contact phone Not Specified 2098865493, 141 <br /> Contact email 142 <br /> Mail invoices to -ewnel" r�� <br /> Program record [ ] HMBP [ ] SOd HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ j 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 W'-ard by: Date: <br /> -------------- 1��----- - ----------/----------------- <br /> Accounting: Reviewed by:--- —Date: Clerical: File Relabel file [ j Create new file <br /> {A_Ac--st-billed: &� urchatge ve fled � 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 PR0525464 not assigned Active [ ] [ ] <br /> s' 2840-AST EXEMPT FAC'-'1;320 GAL PR0529315 _WILLY NG Active,Exempt [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PR0532687 not assigned Inactive [ ] [ <br />