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SAN JOAQU OUNTY ENVIRONMENTAL HEALTAWARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run' 1/12/2016 <br />Submitted on: 1/8/2016 2:02:15PM CERS ID: 10415722 <br />Submitted by: Janice Maclntosch Email: ]macintosh@mbmfoodservice.com Facility ID in CERS: FA0010295 <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />Number of Facilities for this Owner: 1 <br />(current submittal) <br />field <br />Owner ID <br />OW0008295 <br />City Tracy <br />Tracy <br />Owner name <br />MBM, Inc. <br />MSM A Wholly Owned Subsidiary of McL <br />111 <br />Mailing address <br />2641 Meadowbrook Road <br />2641 Meadowbrook Road <br />113 <br />26030 S Corporate Ct <br />Rocky Mount, NC 27801 <br />Rocky Mount, NC 27801 <br />114, 115, 116 <br />Work phone <br />252-985-7200 <br />(252) 985-7200 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID FA0010295 <br />Facility name MBM, Inc. (DC33) <br />MBM A Wholly Owned Subsidiary of McL 3 <br />Site address 26030 S Corporate Ct <br />26030 S Corporate Ct <br />103 <br />City Tracy <br />Tracy <br />104 <br />ZIP code 95377 <br />95377 <br />105 <br />Facility phone 209-839-8173 <br />(209) 839-8173 <br />102 <br />Facility mailing address 26030 S Corporate Ct <br />26030 S Corporate Ct <br />108a <br />Tracy, CA 95377 <br />Tracy, CA 95377 <br />108b,108c, load <br />BILLING INFORMATION <br />Contact name MBM INC (DC33) <br />Terri Batchelor <br />140 <br />Address 2641 Meadowbrook Road <br />2641 Meadowbrook Road <br />143 <br />Rocky Mount, NC 27801 <br />Rocky Mount, NC 27801 <br />144, 145, 146 <br />Contact phone 252-450-4149 <br />(252) 450-4149 <br />141 <br />Contact email tbatchelor@mbmfoodservice.com <br />tbatchelor@mbmfoodservice.com 142 <br />Mail invoices to Account <br />Program record [ ] HMBP SQG HW [ ] LQG HW <br />[ j RCRA HW New PR#: <br />Q-A'(;L4-0 �dt6 <br />created [ ] Tiered permit [ ] APSA [ ] CalARP <br />[ ] UST New PE: <br />11'rLO <br />Assigned to: _ &r-Ck&-'rK" <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year <br />[ ] exempt from billing <br />Processed through CERS Integration Wizard by: <br />-------------------------------------------------- <br />Date: 2 1 ip <br />Accountin.Reviewed by: %16 Date: lh3Up <br />Clerical: [ ] File [ ] Relabel <br />file [ ] Create new file <br />— — — [ ] Acct billed [ ] Surcharge verified <br />----------------------------- <br />By: <br />Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status <br />Reactivated Inactivated <br />1921 - HMBP-Regular-Pdmary Location PRO520213 PETER LOMBARDI Active <br />[ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510295 HAZ MAT SJC OES Inactive <br />[ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE 171 PR0533582 not assigned <br />Inactive <br />[ ] [ ] <br />