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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 311312015 <br />Submitted on: 1/1312015 10:35:48AM <br />Submitted by: Paul Bourbeau Email: bourbeau95215@gmail.com <br />Information prior to CIW processing <br />OWNER INFORMATION (current EC database) <br />Owner ID OW0014267 <br />Owner name BOURBEAU RANCH <br />Mailing address 16865 GAWNE RD <br />COLLEGEVILLE, CA 95215 <br />Work phone <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0017426 <br />Facility name <br />BOURBFAU RANCH <br />Site address <br />16865 GAWNE RD <br />City <br />COLLEGEVILLE <br />ZIP code <br />95215 <br />Facility phone <br />209-462-4508 <br />Facility mailing address 16865 GAWNE RD <br />COLLEGEVILLE, CA 95215 <br />BILLING INFORMATION <br />Contact name BOURBEAU RANCH <br />Address 16865 GAWNE RD <br />COLLEGEVILLE, CA 95215 <br />Contact phone Not Specified <br />Contact email <br />Mail invoices to Owner <br />CERS ID: 10186437 <br />Facility ID in CERS: FA0017426 <br />Information after CIW processing CERS <br />(current submittal) field <br />BOURBEAU RANCH 111 <br />16865 GAWNE RD 113 <br />COLLEGEVILLE, CA 95215 114, 115,116 <br />(209) 462-4508 112 <br />BOURBEAU RANCH <br />3 <br />16865 GAWNE RD <br />103 <br />COLLEGEVILLE <br />104 <br />95215 <br />105 <br />(209) 462-4508 0 <br />102 <br />16865 GAWNE RD <br />108a <br />COLLEGEVILLE, CA 95215 <br />108b, 108c, 108d <br />BOURBEAU RANCH 140 <br />16865 GAWNE RD 143 <br />COLLEGEVILLE, CA 95215 144, 145. 146 <br />(209) 462-4508 141 <br />142 <br />Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: MF- Q93` 23_7 <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: _ _ 1 � TD <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, 9ZL6 Date: V ill <br />Accounting: Reviewed by: _L4_ _ Date: a 1 l Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ Acct billed [ ] Surcharge verified _ _ _ _ _ By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1958 - HM -Farm Operations <br />PR0525611 <br />JAMIE DE LA ROSA <br />Active [ 1 l ] <br />2830 - AST FAC - SPCC EXEMPT <br />PR0529724 <br />STACY RIVERA <br />Active [ ] [ ] <br />FRSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0532096 <br />not assigned <br />Inactive [ ] [ ] <br />4W "-- 2 l/ q (P1 D <br />