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SAN JOAQUi,.-%_'OUNTY ENVIRONMENTAL HEALTH-VEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 3/16/2015 <br /> Submitted on: 3/16/2015 10:50:57AM CERS ID: 10187225 <br /> Submitted by: Tim Gomes Email: egometal1@yahoo.com Facility ID in CERS: FA0019400 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0015900 <br /> Owner name GOMES, TIMOTHY DOMES, TIMOTHY 111 <br /> Mailing address 27054 S AUSTIN RD 27054 S AUSTIN RD 113 <br /> RIPON, CA 95366 RIPON, CA 95366 114, 115,116 <br /> Work phone 2099851048 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019400 <br /> Facility name COMES, TIMOTHY DOMES; TIMOTHY 3 <br /> Site address 27054 S AUSTIN RD 27054 S AUSTIN RD 103 <br /> City RIPON RIPON 104 <br /> ZIP code 95366 95366 105 <br /> Facility phone 000-000-0000 2099851048 102 <br /> Facility mailing address 27054 SAUSTIN RD 27054 SAUSTIN RD 108a <br /> RIPON, CA 95366 RIPON, CA 95366 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name DOMES, TIMOTHY COMES, TIMOTHY 140 <br /> Address 27054 S AUSTIN RD 27054 S AUSTIN RD 143 <br /> RIPON, CA 95366 RIPON, CA 95366 144, 145, 146 <br /> Contact phone Not Specified 2099851048 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record [N1 HMBPr4 SQG HW [ ] LQG HW [ ] RCRA HW New PR#: 53 5 5 39%-1�f <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 1 <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 /> Accounting: Reviewed by: t45 Date: !�' , Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> Acct billed VI Surcharge verified By: Date: <br /> ACTIVE PROGRAM 'RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description. Record ID Employee name Status Reactivated Inactivated <br /> 2830-AST FAC -SPCC EXEMPT PRO529046 ELENA MANZO Active, Exempt [ ] [ ] <br /> -_0-- (Q 4 ��'-�> <br />