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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/16/2015 <br /> Submitted on: 1/5/2015 11:11:49AM CERS ID: 10185941 <br /> Submitted by John Kirschenman Email: ik7506@live.com Facility ID in CERS FA0017130 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0013971 <br /> Owner name KIRSCHENMAN FARMS KIRSCHENMAN FARMS 111 <br /> Mailing address 13145 N LOWER SACRAMENTO RD 13145 N Elderberry Court 113 <br /> LODI, CA 95242 LODI, CA 95242 114, 115, 116 <br /> Work phone 209-649-8473 209-6498473 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017130 <br /> Facility name KIRSCHENMAN FARMS KIRSCHENMAN FARMS 3 <br /> Site address 13145 N LOWER SACRAMENTO RD 13145 N Elderberry Court 103 <br /> City LODI LODI 104 <br /> ZIP code 95242 95242 105 <br /> Facility phone 209-649-8473 209-6498473 102 <br /> Facility mailing address 13145 N LOWER SACRAMENTO RD 13145 N Elderberry Court 108a <br /> LODI, CA 95242 LODI, CA 95242 108b, 108c,10sd <br /> BILLING INFORMATION <br /> Contact name KIRSCHENMAN FARMS KIRSCHENMAN FARMS 140 <br /> Address 13145 N LOWER SACRAMENTO RD / 13145 N Elderberry Court 143 <br /> LODI, CA 95242 LODI, CA 95242 144. 145, 146 <br /> Contact phone 209-649-8473 209-6498473 141 <br /> Contact email 142 <br /> Mail invoices to r ' <br /> Program record [ ] HMBP [ ] SOG HW [ ] LQG HW [ J RCRA HW New PR#: <br /> created [ J Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> ` <br /> Processed through CERS Integration Wizard by: WIv Date: �' b t`� <br /> Accounting: Reviewed by: Date: 3 (D —Clerical: [ ] File [ Relabel file [ ] Create new file <br /> —-- <br /> [ ] Acct billed [ ] 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 PR0525315 JAMIE DE LA RASA Active <br /> 2220-SM HW GEN<5 TONS/YR PRO530427 ARIS VELOSO Active [ ] [ ] <br /> 2830-AST FAC -SPCC EXEMPT PRO530426 ARIS VELOSO Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO532504 not assigned Inactive [ ] [ ] <br /> P-C-N 0 VC4-L V-1eo t#-j QA�C�L. V1C.tif�(� <br />