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SAN JOAQUh,, ,:OUNTY ENVIRONMENTAL HEALTh jEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard Date run: 7'/8/2014 <br />Submitted on: 1/28/2014 11:18:35AM CERS ID: 10401892 <br />Submitted by: Carolyn Des Jardin Email: cdesjardin@3ecompany.com Facility ID in CERS: FA0010975 <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />OW0008975 <br />CSK AUTO INC <br />3207 GREY HAWK CT STE 200 <br />CARLSBAD, CA 92010 <br />602-265-9200 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0010975 <br />Facility name <br />O'REILLY AUTO PARTS #3020 <br />Site address <br />309 W DR MARTIN LUTHER KING JR BLV <br />City <br />STOCKTON <br />Zip code <br />95206 <br />Facility phone <br />209-462-5690 <br />Facility mailing address <br />3207 GREY HAWK CT STE 200 <br />CARLSBAD, CA 92010 <br />BILLING INFORMATION <br />Information after CIW processing <br />(current submittal) <br />CSK Auto, Inc. <br />702 E. Bethany Home Road <br />Phoenix, AZ 85014 <br />(417) 862-3333 <br />CERS <br />field <br />111 <br />113 <br />114, 115, 116 <br />112 <br />O'Reilly Auto Parts #3020 <br />3 <br />309 W Dr Martin Luther King Jr Blvd <br />103 <br />Stockton <br />104 <br />95206 <br />105 <br />209-462-5690 <br />102 <br />3E Company, Regulatory Dept./O'Reilly Autc 108a <br />Carlsbad, CA 92010 108b, 108c, 108d <br />Contact name O'REILLY AUTO PARTS #3020 3E Company, Regulatory Dept./O'Reilly Autc 140 <br />Address 3207 GREY HAWK CT STE 200 3207 Grey Hawk Court, Suite 200 143 <br />CARLSBAD, CA 92010 Carlsbad, CA 92010 144, 145, 146 <br />Contact phone Not Specified 760-602-8700 141 <br />Contact email regulatory@3ecompany.com 142 <br />Mail invoices to <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: <br />Date: <br />Accounting: Reviewed by:. )Z— Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] ActJffled [ ]Sur ge veri ied By: Date: <br />ITA-fi a7 ZiZrlt"l IT7TXdi7 7I'12._1[@] 1107a:leis]**iIkq[CA do U61ILM[91'1'1 <br />Program Element and Description <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location <br />PR0520583 <br />ROBERT LOPEZ <br />Active [ ] [ ] <br />2227 - GEN 5<25 TONS PERMIT <br />PR0514477 <br />MICHELLE HENRY <br />Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PR0510975 <br />HAZ MAT SJC DES <br />Inactive [ ] [ ] <br />2840 - AST EXEMPT FAC < 1,320 GAL <br />PR0530710 <br />STACY RIVERA <br />Active, Exempt [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE F <br />PR0534659 <br />not assigned <br />Inactive [ ] [ ] <br />