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SAN JOAQUh, BOUNTY ENVIRONMENTAL HEALTI-. :PARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 3/16/2015 Submitted on: 3/16/2015 10:50:57AM CERS ID: 10187225 Submitted by: Tim Gomes Email: egometal1@yahoo.com Facility ID in CERS: FA0019400 OWNER INFORMATION Owner ID Owner name Mailing address Work phone Information prior to CIW processing (current EC database) OW0015900 COMES, TIMOTHY 27054 S AUSTIN RD RIPON, CA 95366 FACILITY FILE INFORMATION Facility ID FA0019400 Facility name GOMES, TIMOTHY Site address 27054 S AUSTIN RD City RIPON ZIP code 95366 Facility phone 000-000-0000 Facility mailing address 27054 S AUSTIN RD Information after CIW processing CERS (current submittal) field GOMES, TIMOTHY 111 27054 S AUSTIN RD 113 RIPON, CA 95366 114, 115, 116 2099851048 112 COMES, TIMOTHY 3 27054 S AUSTIN RD 103 RIPON 104 95366 105 2099851048 102 27054 S AUSTIN RD 108a RIPON, CA 95366 108b,108c,108d GOMES, TIMOTHY 140 27054 S AUSTIN RD 143 RIPON, CA 95366 144, 145, 146 2099851048 141 142 Program record HMBP'' SQG HW [ ] LQG HW [ ] RCRA HW New PR#: 5734'KI'5 39 4S9 f created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: ! 95$ vys. / Assigned to: i Please bill: [ -]` full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: Date: Accounting: Reviewed by: Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file klAcct billed �(] Surcharge verified _ —By:— — _ Date_--- -----t�---------- ----- -- ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 2830 - AST FAC - SPCC EXEMPT PR0529046 ELENA MANZO Active, Exempt I ] [] RIPON, CA 95366 BILLING INFORMATION Contact name GOMES, TIMOTHY Address 27054 SAUSTIN RD RIPON, CA 95366 Contact phone Not Specified Contact email Mail invoices to Facility Information after CIW processing CERS (current submittal) field GOMES, TIMOTHY 111 27054 S AUSTIN RD 113 RIPON, CA 95366 114, 115, 116 2099851048 112 COMES, TIMOTHY 3 27054 S AUSTIN RD 103 RIPON 104 95366 105 2099851048 102 27054 S AUSTIN RD 108a RIPON, CA 95366 108b,108c,108d GOMES, TIMOTHY 140 27054 S AUSTIN RD 143 RIPON, CA 95366 144, 145, 146 2099851048 141 142 Program record HMBP'' SQG HW [ ] LQG HW [ ] RCRA HW New PR#: 5734'KI'5 39 4S9 f created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: ! 95$ vys. / Assigned to: i Please bill: [ -]` full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: Date: Accounting: Reviewed by: Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file klAcct billed �(] Surcharge verified _ —By:— — _ Date_--- -----t�---------- ----- -- ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 2830 - AST FAC - SPCC EXEMPT PR0529046 ELENA MANZO Active, Exempt I ] []