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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/29/201 <br /> Submitted on: 12/27/2016 1:08:15PM CERS ID: 10181315 <br /> Submitted by: Mike Hadwick Email: mhadwick@mbmfoodservice.com Facility ID in CERS: FA0003691 <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 OW0016859 <br /> Owner name MBM, Inc (a wholly owned subsidiary of McL MBM, Inc (a wholly owned subsidiary of McLar 111 <br /> Mailing address P.O. Box 800 P.O. Box 800 113 <br /> Rocky Mount, NC 27801 Rocky Mount, NC 27801 114, 115, 116 <br /> Work phone 252-450-4149 (252)450-4149 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003691 <br /> Facility name MBM, Inc. �t 3 <br /> Site address 800 MELON AVE / 800 MELLON AVE 103 <br /> City MANTECA C MANTECA 104 <br /> ZIP code 95337 7 105 <br /> Facility phone 209-823-7157 (209) 823-7157 102 <br /> Facility mailing address 800 Mellon Avenue 800 Mellon Avenue 108a <br /> Manteca, CA 95337 Manteca, CA 95337 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name Terri Batchelor Terri Batchelor 140 <br /> Address PO Box 800 PO Box 800 143 <br /> Rocky Mount, NC 27801 Rocky Mount, NC 27801 144, 145, 146 <br /> Contact phone 252-450-4149 (252)450-4149 141 <br /> Contact email tbatchelor@mbmfoodservice.com tbatchelor@mbmfoodservice.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG 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: kr)V A M Date: IZ1-2q/l(0 <br /> - - -- - -- - - - -- - ------- <br /> Accounting: Reviewed by: Date:l�l30�! L 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 /> 1921 -HMBP-Regular-Primary Location 2 chem units PR0519795 PETER LOMBARDI Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0528551 TWO VACANT2 Active [ ] [ ] <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PRO515468 TWO VACANT2 Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO535045 HARPRIT MATTU Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511929 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PRO507724 ALISON YOUNGBLOOD Inactive [ ] [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231686 ALISON YOUNGBLOOD Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507405 ALISON YOUNGBLOOD Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531733 not assigned Inactive [ ] [ ] <br /> votihed a,ddreis on pard l4 w-rr <br />