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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/1312015 <br /> Submitted on: 4/8/2015 12:36:37PM CERS ID: 10186467 <br /> Submitted by: Susie Browning Email: susie@lassencanyonnursery.com Facility ID in CERS: FA0017452 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014293 <br /> Owner name LASSEN CANYON NURSERY LASSEN CANYON NURSERY 111 <br /> Mailing address 18576 HART LN 18576 HART LN 113 <br /> MANTECA, CA 95336 MANTECA, CA 95336 114, 115, 116 <br /> Work phone 209-599-7777 2095997777 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017452 <br /> Facility name LASSEN CANYON NURSERY LASSEN CANYON NURSERY 3 <br /> Site address 18576 HART LN 18576 HART LN 103 <br /> City MANTECA MANTECA 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 209-599-7777 (209) 599-7777 0 102 <br /> Facility mailing address 18576 HART LN 18576 HART LN 108a <br /> MANTECA, CA 95336 MANTECA, CA 95336 1085,108c, 108a <br /> BILLING INFORMATION <br /> Contact name LASSEN CANYON NURSERY LASSEN CANYON NURSERY 140 <br /> Address P.O. Box P.O, Box 143 <br /> Redding, CA 96099 Redding, CA 96099 144, 145, 146 <br /> Contact phone 530-223-1075 530-223-1075 141 <br /> Contact email 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP (' � SQG HW [ ] LQG HW [ ] RCRA HW New PR#: ?"54000'5 <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: 0% ^� <br /> Please bill: r full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: �kA Date: <br /> Accounting: Reviewed by: Date: 41i4 !S- Clerical: [ ] File [ ] Relabel file N Create new file <br /> [ Acct billed [ ] - By: - . Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1958-HM-Farm Operations PR0525637 MICHAEL PARISSI Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534297 not assigned Inactive [ ] [ ] <br /> �Iv ��G-2/ tq1 <br />