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SAN JOAQU4%.wOUNTY ENVIRONMENTAL HEALTh vor.:PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 5/15/2015 <br /> Submitted on: 5/13/2015 11:45:55AM CERS ID: 10184481 <br /> Submitted by: TREY STEIN HART 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 /> 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 DELTA BLUEGRASS CO 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 Not Specified 209-469-7979 141 <br /> Contact email KDAVIS@DELTABLUEGRASS.COM 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRAHW New PR#: PE LS 4011 in <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 'qd 3 <br /> Assigned to: <br /> Please bill: full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration/Wizardby: 9`71/1 Date: `_ h/�1/Reviewed b : N' Date: Clerical: <br /> ----- --------- ---------- <br /> g: y � ���S [ ] File [ ] Relabel file [ ] Create new file <br /> Acct billed f ] Si-Feehafg^yerifed BYDate: <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 PRO521045 ROBERT LOPEZ Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0534992 HARPRIT MATTU Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO517984 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533129 not assigned Inactive [ ] [ ] <br />