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SAN JOAQUI)VtOUNTY ENVIRONMENTAL HEALTH%ffEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/25/2014 <br /> Submitted on: 3/20/2013 10:03:05AM CERS ID: 10422622 <br /> Submitted by: Dustin Wagner Email: wagnerdairylp@yahoo.com Facility ID in CERS: <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0019892 <br /> Owner name Dustin Wagner Dustin Wagner 111 <br /> Mailing address 22176 Skiff Rd. 22176 Skiff Rd. 113 <br /> Escalon, Ca 95320 Escalon, Ca 95320 114, 115, 116 <br /> Work phone 209-652-5192 209-652-5192 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022462 <br /> Facility name Lazy G Ranch Lazy G Ranch 3 <br /> Site address 5624 E Highway 4 5624 E Highway 4 103 <br /> City Farmington Farmington 104 <br /> Zip code 95230 95230 105 <br /> Facility phone 209-838-7547 209-838-7547 102 <br /> Facility mailing address 22176 Skiff Rd. 22176 Skiff Rd. 108a <br /> Escalon, Ca 95320 Escalon, Ca 95320 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name Dustin Wagner Dustin Wagner 140 <br /> Address 22176 Skiff Rd. 22176 Skiff Rd. 143 <br /> Escalon, CA 96320 Escalon, CA 96320 144, 145, 146 <br /> Contact phone 209-652-5192 209-652-511-9 141 <br /> Contact email wagnerdairylp@yahoo.com a ip@yahoo.com 142 <br /> Mail invoices to Facility 6 K <br /> Program record [ ] HMBP [ ) SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <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:���Date: Z <br /> Accounting: Reviewed by: Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> cctbilled [ ] Surchargevenfie _------_— By: — Date_ <br /> ] u v>� --------------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMBP-Regular-Primary Location PR0539277 ROBERT LOPEZ Active [ ] [ ] <br />