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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 9/29/2015 <br />Submitted on: 9/15/2015 11:56:58AM CERS ID: 10187655 <br />Submitted by: Uyen Huynh Email: superlubeplus@gmail.com Facility ID in CERS: FA0020646 <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 />OW0016968 <br />SUPERLUBE PLUS INC <br />5023 GRAY HAWK LN <br />DUBLIN, CA 94568 <br />209-836-3602 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0020646 <br />Facility name <br />SUPERLUBE PLUS INC <br />Site address <br />1170 LINCOLN BLVD <br />City <br />TRACY <br />ZIP code <br />95376 <br />Facility phone <br />925-785-5443 <br />Facility mailing address 1170 LINCOLN BLVD <br />TRACY, CA 95376 <br />BILLING INFORMATION <br />Contact name SUPERLUBE PLUS INC <br />Address 1170 LINCOLN BLVD <br />TRACY, CA 95376 <br />Contact phone 925-785-5443 <br />C t t H <br />Information after CIW processing CERS <br />(current submittal) field <br />SUPERLUBE PLUS INC 111 <br />1170 LINCOLN BLVD 113 <br />TRACY, CA 95376 114, 115, 116 <br />2098363602 112 <br />SUPERLUBE PLUS INC 3 <br />1170 LINCOLN BLVD 103 <br />TRACY 104 <br />95376 105 <br />2098363602 102 <br />1170 LINCOLN BLVD 108a <br />TRACY, CA 95376 108b, 108c, 108d <br />SUPERLUBE PLUS INC 140 <br />1170 LINCOLN BLVD 143 <br />TRACY, CA 95376 144, 145, 146 <br />2098363602 141 <br />U" ac emal 142 <br />Mail invoices to Fa lity <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: ci0 `j L <br />created [ ] Tiered permit'71fAPSA [ ] CalARP [ ] UST New PE: 2 31, <br />Assigned to: 'T <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 />--------------------------------------------------- <br />Accounting: Reviewed by: t6 Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />char e verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1920 - HMBP-Common Materials <br />PR0540393 <br />PETER LOMBARD] <br />Active [ ] [ ] <br />2227 - GEN 5<25 TONS PERMIT <br />PR0535857 <br />THUY TRAN <br />Active [ ] [ ] <br />2332 - EXEMPT TANK FACILITY <br />PR0535856 <br />THUY TRAN <br />Active, Exempt [ ] [ ] <br />1616 - RETAIL MARKET < 1000 SQ FT W / FOOD PREP <br />PR0535928 <br />MELISSA NISSIM <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0535858 <br />not assigned <br />Inactive [ ] [ ] <br />