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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 12/15/2017 <br /> Submitted on: 11/3/2017 2:14:32PM CERS ID: 10186723 <br /> Submitted by: Madeleine Tevelde Email: mtevelde@pacsouthwestirr.com Facility ID in CERS: FA0017952 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 2 <br /> Owner ID OW0014748 <br /> Owner name CLARE, JAMES C Jim Clare 111 <br /> Mailing address 1310 KERN ST 8372 S JACK TONE RD 113 <br /> ESCALON, CA 95320 STOCKTON, CA 95215 114, 115, 116 <br /> Work phone 209-460-0450 (209) 460-0450 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017952 <br /> Facility name PACIFIC SOUTHWEST IRRIGATION CORF PACIFIC SOUTHWEST IRRIGATION CORP 3 <br /> Site address 8372 S JACK TONE RD 8372 S JACK TONE RD 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95215 95215 105 <br /> Facility phone 209-460-0450 (209) 460-0450 102 <br /> Facility mailing address 8372 S JACK TONE RD 8372 S JACK TONE RD 108a <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name PACIFIC SOUTHWEST IRRIGATION CORF PACIFIC SOUTHWEST IRRIGATION CORP 140 <br /> Address 8372 S JACK TONE RD 8372 S JACK TONE RD 143 <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 144, 145, 146 <br /> Contact phone 209-460-0450 (209) 460-0450 141 <br /> Contact email 142 <br /> Mail invoices to Account <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 /> / <br /> Processed through CERS Integration Wizard by: ✓v-1 H� Date: <br /> -------------------------------------------------- <br /> Accounting: Reviewed by: tA43 Date: J- Z'111-7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] A ed [ ] Surc a verified By: Date: <br /> — -- — ---------------- - <br /> ACTIVE PRO M RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMBP-Regular-Primary Location 10 chem units PR0526511✓ JAMIE LIMA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0539709 ELIANNA FLORIDO Active [ ] [ ] <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATIVE PRO539738 ELIANNAFLORIDO Active ( ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531757 not assigned Inactive [ ] [ ] <br /> c yes '100vcs lt5 PC, XPLM)�- L'1/ <br />