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SAN JOAQUlk'dOUNTY ENVIRONMENTAL HEALTH 15EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/23/2014 <br /> Submitted on: 1/30/2014 12:56:39PM CERS ID: 10181073 <br /> Submitted by: Jim Husting Email:jchust@sbcglobal.net Facility ID in CERS: FA0003206 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0002389 <br /> Owner name WOODBRIDGE GOLF&COUNTRY CLUB WOODBRIDGE GOLF &COUNTRY CLUB 111 <br /> Mailing address PO BOX 806 PO BOX 806 113 <br /> WOODBRIDGE, CA 95258 WOODBRIDGE, CA 95258 114, 115, 116 <br /> Work phone 209-334-5454 209-334-5454 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003206 <br /> Facility name WOODBRIDGE GOLF&COUNTRY CLUB WOODBRIDGE GOLF &COUNTRY CLUB 3 <br /> Site address 800 E WOODBRIDGE RD 800 E WOODBRIDGE RD 103 <br /> City WOODBRIDGE WOODBRIDGE 104 <br /> Zip code 95258 95258 105 <br /> Facility phone 209-334-5454 (209) 334-5454 102 <br /> Facility mailing address PO BOX 806 PO BOX 806 108a <br /> WOODBRIDGE, CA 95258 WOODBRIDGE, CA 95258 108b,108C,toad <br /> BILLING INFORMATION <br /> Contact name WOODBRIDGE GOLF&COUNTRY CLUB WOODBRIDGE GOLF&COUNTRY CLUB 140 <br /> Address PO BOX 806 PO BOX 806 143 <br /> WOODBRIDGE, CA 95258 WOODBRIDGE, CA 95258 144, 145,146 <br /> Contact phone 209-334-5454 209-334-5454 141 <br /> Contact email jchust@sbcglobal.net jchust@sbcglobal.net 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP tpf-SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit p0APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: cfa <br /> Please bill: [ ] full calendar year [ ] prorate <br /> /this <br /> �calendar year [ ] next calendar year [ ] exempt froO billing <br /> Processed through CERS Integration Wizard by: 1 W Date: 61 �( <br /> Accounting: Reviewed by: K-- Date:jg/;967hW Clerical: [ ] File [ ] Relabel file—[ ] Create new file <br /> ,' / y [ Acct billed [ ] Surcharge;er[fied-------------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 /> 1626-RESTAURANT/BAR 101 +SEATS PRO160190 KADEANNE LINHARES Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO519775 JAMIE DE LA ROSA Active <br /> 2220-SM HW GEN<5 TONS/YR PRO538989 Fatina Zareef Active [ ] [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0504679 Fatina Zareef Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0509617 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0538990 Fatina Zareef Active [ ] [ ] <br /> 3611 -PUBLIC POOL/SPA-PRIMARY PR0360498 KADEANNE LINHARES Active [ ] [ ] <br />