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SAN JOAQUIMe,OUNTY ENVIRONMENTAL HEALTH _..PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 12/16/2014 <br /> Submitted on: 1211212014 3:11:20PM CERS ID: 10185473 <br /> Submitted by: Clarke Marek Email: zottranch@aol.com Facility ID in CERS: FA0016825 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013666 <br /> Owner name ZOTTARELLI RANCH ZOTTARELLI RANCH 111 <br /> Mailing address 13101 S HWY 99 13101 S HWY 99 113 <br /> MANTECA, CA 95336 MANTECA, CA 95336 114, 115, 11C <br /> Work phone 209 8230110 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016825 <br /> Facility name ZOTTARELLI RANCH ZOTTARELLI RANCH 3 <br /> Site address 13101 S HWY 99 13039 S HWY 99 103 <br /> City MANTECA 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 209-823-0110 (209) 823-0110 0 102 <br /> Facility mailing address 13101 S HWY 99 MANTECA 13101 S HWY 99 108a <br /> MANTECA, CA 95336 MANTECA, CA 95336 10eb,1o8c,1oe <br /> BILLING INFORMATION <br /> Contact name ZOTTARELLI RANCH ZOTTARELLI RANCH 140 <br /> Address 13101 S HWY 99 13101 S HWY 99 143 <br /> MANTECA, CA 95336 MANTECA, CA 95336 1.44, 145, 14f <br /> Contact phone Not Specified 209 823 0110 141 <br /> Contact email 142 <br /> Mail invoices to Owner 4✓ <br /> Program record { j HMBP fk] SQG HW [ j LOG HW [ ] RCRA HW New PR#: 053 C1 6-72 <br /> created [ ] Tiered permit j j APSA [ ] CaIARP [ ] UST New PE: 2-2— ✓ <br /> Assigned to: ;'etc. <br /> Please bill: ] ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: j ILI <br /> Accounting: Reviewed by: Date:` Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acc fled [ ] 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 /> 1958-HM-Farm Operations PRO525010 MICHAEL PARISSI Active [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO530573 WILLY NG Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532744 not assigned Inactive [ ] [ ] <br />