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SAN JOAQUI94tOUNTY ENVIRONMENTAL HEALTH lYtPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 8/31/2015 <br /> Submitted on: 8/28/2015 1:30:32PM CERS ID: 10186697 <br /> Submitted by: Ralph Cardona Email: cardonajuan@bfusa.com Facility ID in CERS: FA0017929 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0014725 <br /> Owner name SPEEDCO INC SPEEDCO INC 111 <br /> Mailing address PO BOX 520 535 Mariott Drive 113 <br /> CAYUGA, IN 47928 Nashville, TN 37214 114, 115, 116 <br /> Work phone 765-492-5268 615-937-1000 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017929 <br /> Facility name SPEEDCO SPEEDCO 3 <br /> Site address 1515 HOFF DR 1515 HOFF DR 103 <br /> City RIPON RIPON 104 <br /> ZIP code 95366 95366 105 <br /> Facility phone 209-599-7961 (209) 599-7961 102 <br /> Facility mailing address PO BOX 520 2000 Bandag Drive 108a <br /> CAYUGA, IN 47928 Muscatine, IA 52761 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name SPEEDCO SPEEDCO 140 <br /> Address PO BOX 187 535 Mariott Drive 12th Floor 143 <br /> LAVERGNE, TN 37086 Nashville, TN 37214 144, 145, 146 <br /> Contact phone 765492-5268 615-937-1000 141 <br /> Contact email 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: U Date: <br /> - ---- - ---------------------------- --- ----------- <br /> Accounting: Reviewed by: L6 Date: R I tJ Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified g <br /> - -- --------- - -- — y: Date: <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 PR0526534 MICHAEL PARISSI Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0538579 ELENA MANZO Active [ ] [ ] <br /> 2832-AST FAC 10K-</=100 K GAL CUMULATIVE PRO528646 ELENAMANZO Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0526488 BENJAMIN ESCOTTO Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531876 not assigned Inactive [ ] [ ] <br />