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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 11/24/2015 <br />Submitted on: 11/21/2015 11:11:40AM <br />Submitted by: Brent Boersma Email: brentboersma@gmail.com <br />CERS ID: 10417348 <br />Facility Ip in CERS: FA0003581 <br />Information prior to CIW processing <br />Information after CIW processing cessing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Ripon <br />Number of Facilities for this Owner: 1 <br />ZIP code 95366 <br />95366 <br />Owner ID <br />OW0002687 <br />209-550-1597 <br />102 <br />Owner name <br />Brent Boersma <br />Brent Boersma <br />111 <br />Mailing address <br />15326 E. Hwy 120 <br />15326 E. Hwy 120 <br />113 <br />I <br />Ripon, CA 95366 <br />Ripon, CA 95366 <br />114, 115, 116 <br />Work phone <br />209-599-3470 <br />209-599-3470 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID FA0003581 <br />Facility name Boersma Farms, LP <br />Boersma Farms, LP <br />3 <br />Site address 15326 E HWY 120 <br />15326 E. Hwy 120 <br />103 <br />City Ripon <br />Ripon <br />104 <br />ZIP code 95366 <br />95366 <br />105 <br />Facility phone 209-599-3470 <br />209-550-1597 <br />102 <br />Facility mailing address 15326 E. Hwy 120 <br />15326 E. Hwy 120 <br />108a <br />Ripon, CA 95366 <br />Ripon, CA 95366 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />I <br />Contact name Boersma Farms, LP <br />Brent Boersma <br />140 <br />Address 15326 E. Hwy 120 <br />15326 E. Hwy 120 <br />143 <br />Rlpon, CA 95366 <br />Rlpon, CA 95366 <br />144, 145, 146 <br />Contact phone 209-550-1597 <br />209-550-1597 <br />141 <br />Contact email brentboersma@gmail.com <br />brentboersma@gmail.com <br />142 <br />Mail invoices to Account <br />i <br />Program record HMBP [ ] SQG HW [ ] LQG HW <br />[ ] RCRA HW New PR#: <br />gp540( 00 <br />created [ ] Tiered permit APSA [ ] CalARP <br />[ ] UST New PE: <br />IUD O <br />JX <br />3 fG1�l.nl,C--its <br />Assigned to: <br />; I`I;�� L.Ge rer' <br />Please bill: [ ] full calendar year [ ] prorate this calendar year jSC] next calendar year [ <br />] exempt from billing <br />Processed through CERS Integration Wizard by: <br />Date: <br />------------------ -- ------- <br />Accounting: Reviewed by: t1� Date: If /2-5/) 5_ - <br />—---------- <br />Clerical: [ ] File [ ] Relabel <br />--- <br />file [ ] Create new file <br />[ ] Acct billed ( ] Surcharge verified <br />By: <br />Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status <br />keactivated Inactivated <br />2220 - SM HW GEN <5 TONSNR PR0539237 ELENA MANZO Active <br />[ ] [ ] <br />2333 - EXCLUDED UST FACILITY PR0234059 ALISON <br />YOUNGBLOOD Inactive <br />[ ] [ ] <br />As -r <br />f; K16 -A Z -o <br />