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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 1/1612015 <br /> Submitted on: 1/812015 10:20:06AM CERS ID: 10185541 <br /> Submitted by: Belt Ballatore Email:jackieballatore@velociter.net Facility ID in CERS: FA0016869 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013710 111 <br /> Owner name BALLATORE RANCH BALLATORE RANCH <br /> Mailing address 19988 S CARROLTON 19988 S CARROLTON 113 <br /> RIPON, CA 95366 RIPON, CA 95366 114, 115, 116 <br /> Work phone 101-855-41 10185541 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016869 3 <br /> Facility name BALLATORE RANCH BALLATORE RANCH <br /> Site address 19988 S CARROLTON 19988 S CARROLTON 103 <br /> City RIPON RIPON 104 <br /> ZIP code 95366 95366 105 <br /> Facility phone 209-599-3476 (209) 599-3476 102 <br /> Facility mailing address 19988 S CARROLTON 19988 S CARROLTON 108a <br /> RIPON, CA 95366 RIPON, CA 95366 108b,108c,1o8d <br /> BILLING INFORMATION <br /> Contact name BALLATORE RANCH BALLATORE RANCH 140 <br /> Address 19988 S CARROLTON 19988 S CARROLTON 143 <br /> RIPON, CA 95366 RIPON, CA 95366 1a4, 14 146 <br /> Contact phone 101-855-41 10185541 1411 <br /> 142 <br /> Contact email <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: 22� <br /> Assigned to: ("Ar4`1-0 <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: lam' <br /> Accounting: Reviewed by: 146 Date: f 1 11 s Clerical: File [ } Relabel file �9 Create new file <br /> ] Acct billed [ ] Surcharge verified __ _ __By: __ Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Pro ram Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1958-HM-Farm Operations PRO52 0054 MICHAEL PARISSI Active [ [ <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0529266 WILLY NG Inactive [ l [ l <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534359 not assigned Inactive <br />