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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 1/8/2016 Submitted on: 1/7/2016 10:03:32AM Submitted by: Verna Corbett Email: vcorbett@sardee.com OWNER INFORMATION Owner ID Owner name Mailing address Work phone Information prior to CIW processing (current EC database) Number of Facilities for this Owner: 1 OW0007228 Steven R. Sarovich 5100 Academy Drive, Suite 400 Lisle, IL 60532 630-824-4200 MT91 141wda14:81ki17#]Nl , FA Ito] ill I Facility ID FA0009228 Facility name Sardee Industries, Inc. Site address 2731 E MYRTLE ST City Stockton ZIP code 95205 Facility phone 209-466-1526 Facility mailing address 5100 Academy Drive, Suite 400 Lisle, IL 60532 BILLING INFORMATION Contact name Steven R. Sarovich Address 5100 Academy Drive, Suite 400 Lisle, IL 60532 Contact phone 630-824-4200 Contact email ssarovich@sardee.com Mail invoices to Account CERS ID: 10131094 Facility ID in CERS: FA0009228 Information after CIW processing CERS (current submittal) field Steven R. Sarovich 111 5100 Academy Drive, Suite 400 113 Lisle, IL 60532 114, 115, 116 630-824-4200 112 Sardee Industries, Inc. 3 2731 E. Myrtle Street 103 Stockton 104 95205 105 209-466-1526 102 5100 Academy Drive, Suite 400 108a Lisle, IL 60532 108b,108c,108d Steven R. Sarovich 140 5100 Academy Drive, Suite 400 143 Lisle, IL 60532 144, 145, 146 630-824-4200 141 ssarovich@sardee.com 142 Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: F% 1") CC 7`I created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [i+]. full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: Date: 1 I -------------------------------------------------- Accounting: Reviewed by: G2J Date: /lo Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] Acct billed [ ] Surcharge verified By: Date: -------------------------------------------------- ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 1921 - HMBP-Regular-Primary Location PR0519660 HAZA SAEED Active [ ] [ ] 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0509228 HAZ MAT SJC OES Inactive ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0532547 not assigned Inactive [ ] [ ]