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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 5/31/2017 <br /> Submitted on: 5/30/2017 7:48:48AM CERS ID: 10181209 <br /> Submitted by: Sanjay Birla Email: sbgasandmarket@yahoo.com Facility ID in CERS: FA0003539 <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 OW0002646 <br /> Owner name BIRLA, SANJAY BIRLA, SANJAY 111 <br /> Mailing address PO BOX 5527 PO BOX 5527 113 <br /> HAYWARD, CA 94545 HAYWARD, CA 94545 114, 115, 116 <br /> Work phone 510-414-5390 (510)414-5390 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003539 <br /> Facility name S B GAS & MARKET S B GAS & MARKET 3 <br /> Site address 515 W ELEVENTH ST STE 301 515 W ELEVENTH ST STE 301 103 <br /> Ci TRACY 104 <br /> ZIP code 95376 95376Y 105 <br /> Facility phone 209-834-8838 (209) 834-8838 102 <br /> Facility mailing address 515 W ELEVENTH ST STE 301 PO BOX 55277 108a <br /> TRACY, CA 95376 HAYWARD, CA 94545 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name S B GAS & MARKET S B GAS & MARKET 140 <br /> Address 515 W ELEVENTH ST STE 301 PO BOX 55277 143 <br /> TRACY, CA 95376 HAYWARD, CA 94545 144, 145, 146 <br /> Contact phone 209-834-8838 (209) 834-8838 141 <br /> Contact email sbgasandmarket@yahoo.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ j UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ I prorate this calendar year [ ] next calendarear <br /> y [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: 0" lc-�— Date: C) <br /> Accounting: Reviewed by: L6 Date: WOO Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed ( ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1615-RETAIL MKT 301-2000 SQ FT(PREPKGD/LTD PREP; PRO505685 MELISSA NISSIM Active [ ] [ ] <br /> 1920-HMBP-Common Materials 5 chem units PRO520002 NICHOLAS LOEHRER Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0518518 BETTY HO Active [ ] [ ] <br /> 2361 -UST FACILITY PR0231400 BETTY HO Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512788 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PR0508283 STEVE SASSON Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507345 STEVE SASSON Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532062 not assigned Inactive [ ] [ ] <br />