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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 11/2/2015 <br />Submitted on: 10/30/2015 10:51:09AM CERS ID: 10140045 <br />Submitted by: Deborah Williams Email: deborah.j.williams@autozone.com Facility ]Din CERS: FA0011255 <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 />Number of Facilities for this Owner : 1 <br />OW0009255 <br />AutoZone Stores Inc <br />123 South Front Street <br />Memphis, TN 38103 <br />901-495-6500 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0011255 <br />Facility name <br />AutoZone #5686 <br />Site address <br />1448 N ELDORADO ST <br />City <br />Stockton <br />ZIP code <br />95202 <br />Facility phone <br />209-939-9132 <br />Facility mailing address Dept 8190, 123 South Front Street <br />Information after CIW processing CERS <br />(current submittal) field <br />AutoZone Stores Inc 111 <br />123 South Front Street 113 <br />Memphis, TN 38103 114, 115, 116 <br />901-495-6500 112 <br />AutoZone #5686 <br />Memphis, TN 38103 <br />BILLING INFORMATION <br />103 <br />Contact name <br />Bryan Blair <br />Address <br />Dept 8190, 123 South Front Street <br />209-939-9132 <br />Memphis, TN 38103 <br />Contact phone <br />901-495-7217 <br />Contact email <br />bryaR.blair@autozone.com <br />Mail invoices to <br />Own6r ,A <br />Information after CIW processing CERS <br />(current submittal) field <br />AutoZone Stores Inc 111 <br />123 South Front Street 113 <br />Memphis, TN 38103 114, 115, 116 <br />901-495-6500 112 <br />AutoZone #5686 <br />3 <br />1448 N EI Dorado St <br />103 <br />Stockton <br />104 <br />95202 <br />105 <br />209-939-9132 <br />102 <br />Dept 8190, 123 South Front Street 108a <br />Memphis, TN 38103 108b, 108c, 108d <br />Deborah Williams 140 <br />Dept 8190, 123 South Front Street 143 <br />Memphis, TN 38103 144, 145, 146 <br />901495-7129 141 <br />deborah.j.williams@autozone.com 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />i <br />Processed through CERS Integration Wizard by: ( '' Date: I- a ( ~ <br />Accounting: Reviewed by: LJ Date: 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 />1921 - HMBP-Regular-Primary Location PRO520785 ROBERT LOPEZ Active [ ] [ ] <br />2220 - SM HVV GEN <5 TONS/YR PR0535766 MICHELLE HENRY Active [ ] ( ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511255 HAZ MAT SJC OES Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0532193 not assigned Inactive [ ] [ ] <br />