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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/12/2016 <br />Submitted on: 1/8/2016 2:02:15PM <br />Submitted by: Janice Maclntosch Email: jmacintosh@mbmfoodservice.com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner: 1 <br />OW0008295 <br />MBM, Inc. <br />2641 Meadowbrook Road <br />Rocky Mount, NC 27801 <br />252-985-7200 <br />FACILITY FILE INFORMATION <br />CERS ID: 10415722 <br />Facility ID in CERS: FA0010295 <br />Information after CIW processing CERS <br />(current submittal) field <br />MBM A Wholly Owned Subsidiary of McL; 111 <br />2641 Meadowbrook Road 113 <br />Rocky Mount, NC 27801 114, 115, 116 <br />(252) 985-7200 112 <br />Facility ID <br />FA0010295 <br />Terri Batchelor <br />140 <br />Facility name <br />MBM, Inc. (DC33) <br />MBM A Wholly Owned Subsidiary of McL; <br />3 <br />Site address <br />26030 S Corporate Ct <br />26030 S Corporate Ct <br />103 <br />City <br />Tracy <br />Tracy <br />104 <br />ZIP code <br />95377 <br />95377 <br />105 <br />Facility phone <br />209-839-8173 <br />(209) 839-8173 <br />102 <br />Facility mailing address <br />26030 S Corporate Ct <br />26030 S Corporate Ct <br />108a <br />Tracy, CA 95377 <br />Tracy, CA 95377 <br />108b, 1080, 108d <br />BILLING INFORMATION <br />Contact name <br />MBM INC (DC33) <br />Terri Batchelor <br />140 <br />Address <br />2641 Meadowbrook Road <br />2641 Meadowbrook Road <br />143 <br />Rocky Mount, NC 27801 <br />Rocky Mount, NC 27801 <br />144, 145, 146 <br />Contact phone <br />252-450-4149 <br />(252) 450-4149 <br />141 <br />Contact email <br />tbatchelor@mbmfoodservice.com <br />tbatchelor@mbmfoodservice.com <br />142 <br />Mail invoices to <br />Account <br />Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: `'t-0 Pc6c j <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: q l rw <br />Assigned to: AAt CWN(--`1 <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: livr�l Date: <br />-------------------------------------------------- <br />Accounting: Reviewed by: W5 Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />-------------------------------------------------- <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated Inactivated <br />°'9921 - HMBP-Regular-Primary Location PR0520213 PETER LOMBARDI Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510295 HAZ MAT SJC OES Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0533582 not assigned Inactive [ ] ( ] <br />