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SAN JOAQUItrrCOUNTY ENVIRONMENTAL HEALTFt401EPARTMENT <br /> Changes to EnvisionConnect by CERS integration Wizard <br /> Date run: 1/20/2015 <br /> Submitted on: 1/7/2015 11:54:34AM CERS la: 10186575 <br /> Submitted by: Brian Jungeblut Email:jnglbuni@caldsl.net Facility ID in CERS: FA0017517 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014358 <br /> Owner name D&B JUNGEBLUT D&B JUNGEBLUT 111 <br /> Mailing address 5827 E KETTLEMAN LN 5827 E KETTLEMAN LN 113 <br /> LODI, CA 95240 LODI, CA 95240 114, 115, 116 <br /> Work phone 209-368-1254 2093681254 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017517 <br /> Facility name D&B JUNGEBLUT D&B JUNGEBLUT 3 <br /> Site address 5827 E KETTLEMAN LN 5827 E KETTLEMAN LN 103 <br /> City LODI LODI 104 <br /> ZIP code 95240 95240 105 <br /> Facility phone 209-368-1254 (209)368-1254 0 102 <br /> Facility mailing address 5827 E KETTLEMAN LN 5827 E KETTLEMAN LN 108a <br /> LODI, CA 95240 LODI, CA 95240 108e,108c,108d <br /> BILLING INFORMATION <br /> Contact name D&B JUNGEBLUT �/ D&B JUNGEBLUT 140 <br /> Address 5827 E KETTLEMAN LN 5827 E KETTLEMAN LN 143 <br /> LODI, CA 95240 LODI, CA 95240 144, 145, 146 <br /> Contact phone 209-368-1254 2093681254 141 <br /> Contact email 142 <br /> Mail invoices to Qvt er �^ <br /> Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: fZ O 5 3q-1`7'- <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 'L2'L0 <br /> Assigned to: ~150 <br /> Please bill: [ ] full calendar year [ ] prorate,1this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: L�l Date: 'L <br /> Accounting: Reviewed by: Date: 3 eJ Clerical: [ ] File [ ] Relabel file Xcreate new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW L <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1958-HM-Farm Operations PR0525702 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0529494 WILLY NG Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532798 not assigned Inactive [ ] [ ] <br />