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Dale run 1102016 8:14:42AIV SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> •" Facility Information as of 11/3/2016 <br /> Record Selection Cdtena. Facility ID FA0000380 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID <br /> Owner ID OW0000311 New Owner ID <br /> Owner Name Kmart Corporation <br /> Owner DBA <br /> Owner Address 3333 BEVERLY RD 135-34 <br /> HOFFMAN ESTATES, IL 60179 <br /> Home Phone 847-286-0037 <br /> Work/Business Phone 847-286-7994 <br /> Mailing Address 3333 Beverly Road, 135-348A <br /> Hoffman Estates, IL 60179 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0000380 10140709 <br /> Facility Name Kmart#7486 <br /> Location 520 S CHEROKEE LN <br /> Lodi, CA 95240 <br /> Phone 209-333-0220 x <br /> Mailing Address 3333 Beverly Road, 135-348A <br /> Hoffman Estates, IL 60179 <br /> Care of Kmart Corporation <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name EATERY EXPRESS-KMART <br /> Title <br /> Day Phone 209-333-0220 <br /> Night Phone 209-333-0220 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000379 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Cynthia Miller (CirdeOne) <br /> Account Balance as of 11/3/2016: $0.00 <br /> (Circle One) <br /> Transfer to Activalnaclva <br /> Program0ement and Description Re xed 1D Employee ID and Name Status New Owner? Delete <br /> 1618-RETAIL MKT>2000 SO FT (PREPKGD/LTD PRE PRO161841 EE0009488-JEFFREY WONG Active Y N A D <br /> 1921 -HMBP-Regular-Primary Location PR0519900 EE0008709-JAMIE LIMA Active Y N A D <br /> 2220-SM HW GEN<5 TONS/YR PR0529405 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512119 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509831 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> 4557-MED WASTE LIMITED HAULER PR0537988 EE0003973-ROBERT MCCLELLON Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523650 EE5555555-Garrett Alias-Backus Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO531321 Inactive Y N A I D <br />