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SAN JOAQUI*C;OUNTY ENVIRONMENTAL HEALTHVEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/21/2014 <br /> Submitted on: 7/30/2013 5:00:22PM 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 CIM/processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <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 209-834-8838 (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 /> City TRACY TRACY 104 <br /> Zip code 95376 95376 105 <br /> Facility phone 209-834-8838 (209) 834-8838 102 <br /> Facility mailing address PO BOX 55277 PO BOX 55277 108a <br /> HAYWARD, CA 94545 HAYWARD, CA 94545 toeb,toac,109d <br /> BILLING INFORMATION <br /> Contact name S B GAS & MARKET S B GAS & MARKET 140 <br /> Address PO BOX 55277 PO BOX 55277 143 <br /> HAYWARD, CA 94545 HAYWARD, CA 94545 144, 145, 146 <br /> Contact phone 209-835-5148 (209) 834-8838 141 <br /> Contact email sbgasandmarket@yahoo.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG 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: evit Date: 2 <br /> Accounting: Reviewed by: K Dat4dw Clerical: [ ] File [ ] [ 1 <br /> File Relabel file Create new file <br /> [ ] Ac led [ ] Sur chz�xr�or�verified 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 /> 1615-RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PREP; PRO505685 MELISSA NISSIM Active [ ] [ 1 <br /> 1920-HMBP-Common Materials PR0520002 MICHAEL PARISSI Active [ ] I 1 <br /> 2220-SM HW GEN<5 TONS/YR PRO518518 THUY TRAN Active [ ] [ 1 <br /> 2301 -UST STATE SURCHARGE FEE PR0508283 STEVE SASSON Inactive [ ] I 1 <br /> 2361 -UST FACILITY PR0231400 THUY TRAN Active [ ] [ 1 <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507345 STEVE SASSON Inactive [ ] [ 1 <br />