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SAN JOAQUIN UJUNTY ENVIRONMENTAL HEALTH DCPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/17/2014 <br /> Submitted on: 1/31/2014 1:06:14PM CERS ID: 10186793 <br /> Submitted by: John Bacchetti Email: thoming@inreach.com Facility ID in CERS: FA0018149 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014892 <br /> Owner name DEL TERRA FARMS LLC DEL TERRA FARMS LLC 111 <br /> Mailing address 4600 S TRACY BLVD STE 102 33600 S KOSTER RD 113 <br /> TRACY, CA 95377 TRACY, CA 95304 114, 115, 116 <br /> Work phone (209)834-8100 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018149 <br /> Facility name DEL TERRA FARMS LLC DEL TERRA FARMS LLC 3 <br /> Site address 33600 S KOSTER RD 33600 S KOSTER RD 103 <br /> City TRACY TRACY 104 <br /> Zip code 95304 95304 105 <br /> Facility phone 209-683-4810 (209) 834-8100 102 <br /> Facility mailing address 4600 S TRACY BLVD STE 102 33600 S KOSTER RD 108a <br /> TRACY, CA 95377 TRACY, CA 95304 108b,1080,1084 <br /> BILLING INFORMATION <br /> Contact name DEL TERRA FARMS LLC DEL TERRA FARMS LLC 140 <br /> Address 4600 S TRACY BLVD STE 102 33600 S KOSTER RD 143 <br /> TRACY, CA 95377 TRACY, CA 95304 144, 145, 146 <br /> Contact phone Not Specified (209)834-8100 141 <br /> Contact email staceyf@gloriannfarms.com 142 <br /> Mail invoices to Owner <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: <br /> -------------------------------------------------- <br /> Accounting: Reviewed by: � Date:�//��, ff'''' Clerical: '�Jjile [ ] Relabel file [ ] Create new file <br /> Acct"billed Surch r e verifie) By: Date: <br /> --------,c-------- ------------------------- <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 PR0526792 not assigned Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0530975 ELENA MANZO Active [ ] [ ] <br /> 2830-AST FAC -SPCC EXEMPT PR0530974 ELENA MANZO Active, Exempt [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PR0531394 not assigned Inactive [ ] [ ] <br />