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SAN JOAQUI,% ,OUNTY ENVIRONMENTAL HEALTH �LPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 2/27/2015 <br />Submitted on: 1/15/2015 9:22:32AM <br />Submitted by: TREY STEINHART Email: Msevilla@deltabluegrass.com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />OW0000922 <br />ZUCKERMAN-HERITAGE INC <br />PO BOX 487 <br />STOCKTON, CA 95201 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0012675 <br />Facility name <br />ZUCKERMAN HERITAGE -PACKING SHED <br />Site address <br />111 N ZUCKERMAN RD <br />City <br />STOCKTON <br />ZIP code <br />95206 <br />Facility phone <br />209-469-7979 <br />Facility mailing address PO BOX 487 <br />STOCKTON, CA 95201 <br />BILLING INFORMATION <br />Contact name ZUCKERMAN HERITAGE -PACKING SHED <br />Address PO BOX 487 <br />STOCKTON, CA 95201 <br />Contact phone Not Specified <br />Contact email <br />Mail invoices to Owner .i,oQ Z1 D 32 <br />CERS ID: 10184323 <br />Facility ID in CERS: FA0012675 <br />Information after CIW processing CERS <br />(current submittal) field <br />ZUCKERMAN-HERITAGE INC 111 <br />PO BOX 487 113 <br />STOCKTON, CA 95201 114, 115, 116 <br />209-469-7979 112 <br />ZUCKERMAN HERITAGE-MCDONALD <br />3 <br />111 N ZUCKERMAN RD <br />103 <br />STOCKTON <br />104 <br />95206 <br />105 <br />(209) 469-7979 <br />102 <br />PO BOX 487 <br />108a <br />STOCKTON, CA 95201 <br />108b, 108c, 108d <br />KELLY JOPLIN 140 <br />PO BOX 487 143 <br />STOCKTON, CA 95201 144, 145, 146 <br />209-469-7979 141 <br />KJOPLIN@DELTABLUEGRASS.COM 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br />created [ ] Tiered permit [',}'APSA [ ] CalARP [ ] UST New PE: 6.50 <br />Assigned to: 1=cA"'k <br />Please bill: [J] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: 0�1111\ <br />Date: 1_z7_ IS <br />Accounting: Reviewed by: t6 Date: 3%4/15 Clerical: [ ] File [ ] Relabel file [ j Create new file <br />Acct billed <br />rcharge verified � (iSn —_ By: Date_ <br />Asu <br />------------— <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING TReOUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated Inactivated <br />1958 - HM -Farm Operations PR0536319 ROBERT LOPEZ Active [ ] [ ] <br />2221 - USED OIL ONLY - <5 TONSNR PR0538471 FATINAH ZAREEF Active [ ] [ ] <br />1960 - CaIARP EXEMPT FACILITY PR0536302 RAYMOND VON FLUE Inactive [ ] [ ] <br />