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SAN JOAQUIIO-COUNTY ENVIRONMENTAL HEALTHbEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/25/2016 <br /> Submitted on: 1/12/2016 4:24:29PM CERS ID: 10184481 <br /> Submitted by: TREY STEINHART Email: Msevilla@deltabluegrass.com Facility ID in CERS: FA0013641 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0010754 <br /> Owner name ZUCKERMAN HERITAGE, INC ZUCKERMAN HERITAGE, INC 111 <br /> Mailing address PO BOX 487 PO BOX 487 113 <br /> STOCKTON, CA 95201 STOCKTON, CA 95201 114, 115, 116 <br /> Work phone 209-469-7979 209-469-7979 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013641 <br /> Facility name DELTA BLUEGRASS CO DELTA BLUEGRASS CO 3 <br /> Site address 1030 S ARGONAUT 1030 S ARGONAUT 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95204 95204 105 <br /> Facility phone 209-469-7979 209-469-7979 102 <br /> Facility mailing address PO BOX 487 PO BOX 487 108a <br /> STOCKTON, CA 95201 STOCKTON, CA 95201 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name KELLY DAVIS KELLY DAVIS 140 <br /> Address PO BOX 487 PO BOX 487 143 <br /> STOCKTON, CA 95201 STOCKTON, CA 95201 144, 145, 146 <br /> Contact phone 209-469-7979 209-469-7979 141 <br /> Contact email KDAVIS@DELTABLUEGRASS.COM KDAVIS@DELTABLUEGRASS.COM 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: a-05-J-o D'2-to <br /> created [ ] Tiered permit APSA [ ] CaIARP [ ] UST New PE: 2$1l <br /> Assigned to: (L1v�M1ft <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: VAJ Date: ( a <br /> eviewed by:Accountng: RS t b <br /> Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge vers led 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 /> 1921 -HMBP-Regular-Primary Location PR0521045 HAZA SAEED Active [ ] [ ] <br /> J2220-SM HW GEN<5 TONS/YR PRO540116 STACY RIVERA Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0534992 HARPRIT MATTU Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0517984 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533129 not assigned Inactive [ ] [ ] <br />