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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 8/10/2018 <br />Submitted on: 1/31/2018 7:58:09AM CERS ID: 10720927 <br />Submitted by: Aaron Klein Email: aklein@victoryrenewables.com Facility ID in CERS: FA0023780 <br />OWNER INFORMATION <br />Owner I D <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 />OW0022129 <br />Victory Renewables, LLC <br />930 S. Kimball Ave Suite 100 <br />Southlake, TX 76092 <br />817-562-4888 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023780 <br />Facility name <br />VicNRG, LLC <br />Site address <br />916 Davis Ave <br />City <br />Stockton <br />ZIP code <br />95203 <br />Facility phone <br />Facility mailing address <br />916 Davis Ave <br />Stockton, CA 95203 <br />BILLING INFORMATION <br />Contact name <br />Andy Wilson <br />Address <br />930 S. Kimball Ave Suite 100 <br />Southlake, TX 76092 <br />Contact phone <br />817-562-4888 <br />Contact email <br />awilson@victoryrenewables.com <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />Victory Renewables, LLC 111 <br />930 S. Kimball Ave Suite 100 113 <br />Southlake, TX 76092 114, 115, 116 <br />8175624888 112 <br />Victory Renewables, LLC 3 <br />916 Davis Ave 103 <br />Stockton 104 <br />95203 105 <br />same 102 <br />916 Davis Ave 108a <br />Stockton, CA 95203 108b, 108c, 108d <br />Andy Wilson 140 <br />930 S. Kimball Ave Suite 100 143 <br />Southlake, TX 76092 144, 145, 146 <br />8175624888 141 <br />awilson@victoryrenewables.com 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />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: <br />J.Jw✓1 Date: <br />------------------------ <br />Accounting: Reviewed by: V/-> Date: q112 -11V Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location 3 chem units PR0541483 ROBERT LOPEZ Active [] [] <br />