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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/1/2017 <br /> Submitted on: 6/1/2017 8:47:12AM CERS ID: 10181809 <br /> Submitted by: Matt Katicich Email: kmackey@croceco.com Facility ID in CERS: FA0005364 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0004210 <br /> Owner name KATICICH, MATT P KATICICH, MATT P 111 <br /> Mailing address 9974 E FAIRCHILD RD 9974 E FAIRCHILD RD 113 <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 114, 115, 116 <br /> Work phone 209-931-2016 (209) 931-2016 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0005364 <br /> Facility name KATICICH RANCH KATICICH RANCH 3 <br /> Site address 9974 E FAIRCHILD RD 9974 E FAIRCHILD RD 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95215 95215 105 <br /> Facility phone 209-931-2016 (209) 688-4140 102 <br /> Facility mailing address 9974 E FAIRCHILD RD 9974 E FAIRCHILD RD 108a <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name KATICICH RANCH KATICICH RANCH 140 <br /> Address 9974 E FAIRCHILD RD 1101 W. Walnut St 143 <br /> STOCKTON, CA 95215 STOCKTON, CA 95203 144, 145, 146 <br /> Contact phone 209-931-2016 (209) 931-2016 141 <br /> Contact email katicichranch@gmail.com 142 <br /> Mail invoices to Fac�N{y N, <br /> Program record [ ] H BP K [ ] SQG HW [ ] [ QG HW [ ] RCRA HW New PR#: PROSL414155 <br /> created [ ] Tiered permit [ ] APSA [\X CalARP [ ] UST New PE: 11100�. <br /> Assigned to: 1400.g Slicer]/, <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: 7OOV-1 Date: - l't <br /> 6 <br /> Accounting: Reviewed by: Date: �/1 1117 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed ] Surcharge verified By: Date <br /> ---- --—— — — - - -- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1958-HM-Farm Operations 1 chem units PRO525857 MUNIAPPA NAIDU Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0529733 ELIANNA FLORIDO Active [ ] [ ] <br /> 2333-EXCLUDED FARM TANK PR0502210 LETITIA BRIGGS Inactive ( ] [ ] <br /> 2830-AST FAC -SPCC EXEMPT PR0529732 CINDY VO Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534204 not assigned Inactive [ ] [ ] <br /> oewc,e- cLa C ,wp PC 95 . OOVA �- <br /> ApDr604 P(/P- <br /> �,po0 58 2C� <br />