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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 6/9/2016 <br />Submitted on: 4/22/2016 12:02:04PM <br />Submitted by: James Wright Email: james.wright@cleanenergyfuels.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 />OW0021642 <br />Clean Energy <br />4675 MacArthur Court, Suite 800 <br />Newport Beach, CA 92660 <br />949-437-1000 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023411 <br />Facility name <br />Clean Energy - 1250 Madruga Road <br />Site address <br />1250 Madruga Rd <br />City <br />Lathrop <br />ZIP code <br />95330 <br />Facility phone <br />949-437-1000 <br />Facility mailing address 4675 MacArthur Court, Suite 800 <br />Newport Beach, CA 92660 <br />BILLING INFORMATION <br />Contact name James Wright <br />Address 4675 MacArthur Court, Suite 800 <br />Newport Beach, CA 92660 <br />Contact phone 949-437-1207 <br />Contact email james.wright@cleanenergyfuels.com <br />Mail invoices to Account <br />CERS ID: 10642783 <br />Facility ID in CERS: incorrect <br />Information after CIW processing <br />(current submittal) <br />Clean Energy <br />4675 MacArthur Court, Suite 800 <br />Newport Beach, CA 92660 <br />949-437-1000 <br />L"f i�&eSS j Grle 2� <br />ea ergy - 282 Madruga Road <br />j 1262 Madruga R� �d <br />Lathrop c(,?A e <br />` 95330 <br />949-437-1000 <br />4675 MacArthur Court, Suite 800 <br />Newport Beach, CA 92660 <br />James Wright <br />4675 MacArthur Court, Suite 800 <br />Newport Beach, CA 92660 <br />949-437-1207 <br />james.wright@cleanenergyfuels.com <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 />CERS <br />field <br />111 <br />113 <br />114, 115, 116 <br />112 <br />3 <br />103 <br />104 <br />105 <br />102 <br />108a <br />108b, 108c, 108d <br />140 <br />143 <br />144, 145, 146 <br />141 <br />142 <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: ��� /( <br />Accounting: Reviewed by: Date: ID I Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ }- Asc�itled--[-+43urcharge 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 />1921 - HMBP-Regular-Primary Location PR0540909 PETER LOMBARDI Active I I I I <br />