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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/11/2017 Submitted on: 7/10/2017 5:15:55PM CERS ID: 10184481 Submitted by: STEINHART STEINHART Email: steinhart4@sbcglobal.net Facility ID in CERS: FA0013641 Information prior to CIW processing Information after CIW processing CERS OWNER INFORMATION (current EC database) (current submittal) field Number of Facilities for this Owner: 1 Owner ID OW0010754 Owner name ZUCKERMAN HERITAGE, INC ZUCKERMAN HERITAGE, INC 111 Mailing address PO BOX 487 PO BOX 487 113 STOCKTON, CA 95201 Stockton, CA 95219 114, 115, 116 Work phone 209-469-7979 209-469-7979 112 FACILITY FILE INFORMATION Facility ID FA0013641 Facility name DELTA BLUEGRASS CO DELTA BLUEGRASS CO 3 Site address 1030 S ARGONAUT 1030 S ARGONAUT 103 City STOCKTON STOCKTON 104 ZIP code 95204 95204 105 Facility phone 209-469-7979 209-469-7979 102 Facility mailing address PO BOX 487 PO BOX 487 108a STOCKTON, CA 95201 STOCKTON, CA 95201 108b,108c,mad BILLING INFORMATION Contact name KELLY DAVIS Trey Steinhart 140 Address PO BOX 487 PO Box 487 143 STOCKTON, CA 95201 Stockton, CA 95219 144, 145, 146 Contact phone 209-469-7979 2094697979 141 Contact email KDAVIS@DELTABLUEGRASS.COM steinhart4@sbcglobal.net 142 Mail invoices to Account Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: '/fin �— Date: Accounting: Reviewed by: Date: 7117-111Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] Acct billed [ ] Surcharge verifiedBy: Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Record ID Employee name Status Reactivated Inactivated 1921 -HMBP-Regular-Primary Location 6 chem units PRO521045 ROBERT LOPEZ Active [ ] [ ] 2220-SM HW GEN<5 TONS/YR PR0540116 STACY RIVERA Active [ ] [ ] 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0540726 STACY RIVERA Active [ ] [ ] 4740-WASTE TIRE SITE-EXEMPT PR0534992 HARPRIT MATTU Active [ ] [ ] 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0517983 HAZ MAT SJC OES Inactive [ ] [ ] 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO517984 HAZ MAT SJC OES Inactive [ ] [ ] ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533129 not assigned Inactive [ ] [ ]