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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 4/9/2015 <br /> Submitted on: 4/2/2015 2:21:19PM CERS ID: 10181661 <br /> Submitted by: Brian Spears Email: bspears@tractorsupply.com Facility ID in CERS: FA0004567 <br /> In rmation prior to CIW processing Information after CIW processing CERS <br /> (current EC da base) (current submittal) field <br /> OWNER INFORMATION DG00D�D 945- <br /> Owner <br /> ID OW00180 0 K 111 <br /> Owner name ORCHARD PLY HARDWARE LLC Tractor Supply Company 113 <br /> Mailing address PO Box 36 5401 Virginia Way 114, 115,116 <br /> SA SE, CA 9 61-9036 Brentwood,TN 37027 <br /> Work phone -365-2493 615-440-1600 112 <br /> FACILITY FILE INFORM N <br /> Facility ID FA0004567 <br /> Facility name Tractor Supply Company, #1857 Tractor Supply Company, #1857 3 <br /> Site address 360 S Cherokee Ln 360 S Cherokee Ln 103 <br /> City Lodi Lodi 104 <br /> ZIP code 95240 95240 105 <br /> Facility phone 209-369-5528 209-369-5528 102 <br /> Facility mailing address 5401 Virginia Way 5401 Virginia Way 108a <br /> Brentwood, TN 37027 Brentwood, TN 37027 108b 108c,108d <br /> BILLING INFORMATION <br /> Contact name Brian Spears Brian Spears 140 <br /> Address 5401 Virginia Way 5401 Virginia Way 143 <br /> Brentwood, TN 37027 Brentwood, TN 37027 144, 145, 146 <br /> Contact phone 615-440-4115 615-4404115 141 <br /> Contact email bspears@tractorsupply.com bspears@tractorsupply.com 142 <br /> Mail invoices to Account <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: �e/� Date: 4k l k5- <br /> Accounting: Reviewed by: �_Date: 0I/(G s Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials PR0520360 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PRO535764 ARIS VELOSO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510059 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533774 not assigned Inactive [ ] [ ] <br />