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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/25/2014 <br /> Submitted on: 4/21/2014 11:13:40AM CERS ID: 10182565 <br /> Submitted by: TONY MELT Email: tmeli@polyprocessing.com Facility ID in CERS: FA0009284 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0007284 <br /> Owner name ABELL CORP A <br /> B:ELL 111 <br /> Mailing address PO BOX 4150 01 OLD STERLIN3RD. 113 <br /> MONROE, LA 712114150ONROE, LA 71203114, 115, 116 <br /> Work phone 318-343-7565 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009284 <br /> Facility name POLY PROCESSING COMPANY LLC POLY PROCESSING COMPANY LLC 3 <br /> Site address 8055 SASH ST 8055 SASH ST 103 <br /> City FRENCH CAMP FRENCH CAMP 104 <br /> Zip code 95231 95231 105 <br /> Facility phone 209-9824904 (209) 982-4904 102 <br /> Facility mailing address 8055 S ASH ST 8055 S ASH ST 108a <br /> FRENCH CAMP, CA 95231 FRENCH CAMP, CA 95231 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name POLY PROCESSING COMPANY LLC POLY PROCESSING COMPANY LLC 140 <br /> Address 8055 S ASH ST P.O. BOX 4150 143 <br /> FRENCH CAMP, CA 95231 MONROE, LA 71211 144, 145, 146 <br /> Contact phone Not Specified 318-343-7565 141 <br /> Contact email142 <br /> fa <br /> Mail invoices to . wnerR e—I A/ty <br /> Program record [ ] HMBP [ ] SQ HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <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: Clerical: File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge 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 PR0519517 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PRO513746 THUY TRAN Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509284 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532961 not assigned Inactive [ ] [ ] <br />