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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Change to EnvIsionConnect by CERS Integration Wizard <br /> Date run: 4/2/2015 <br /> Submitted on: /11/2015 2:24:31P CERS ID: 10184615 <br /> Submitted by: Eric sminge Email: ee ing@3ecompany.com Facility ID in CERS: FA0014350 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0016236 <br /> Owner name Longs Drug Stores California, L.L.C. Longs Drug Stores California, L.L.C. 111 <br /> Mailing address One CVS Drive One CVS Drive 113 <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 114, 115, 116 <br /> Work phone 401-765-1500 (401) 765-1500 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014350 <br /> Facility name CVS Pharmacy#3908 CVS Pharmacy#3908 3 <br /> Site address 1885 W 11th St 1885 W 11th St 103 <br /> City Tracy Tracy 104 <br /> ZIP code 95376 95376 105 <br /> Facility phone 209-836-1460 (209)836-1460 102 <br /> Facility mailing address ONE CVS DR MAIL DROP 23062A CVS Health,Attn: Dianne E. Durand, Lice 108a <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 10eb,108c,108d <br /> BILLING INFORMATION <br /> Contact name CVS Pharmacy#3908 CVS Health,Attn: Dianne E. Durand, Lice 140 <br /> Address ONE CVS DR MAIL DROP 23062A One CVS Drive–MC23062A 143 <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 144, 145, 146 <br /> Contact phone Not Specified (401)770-3315 141 <br /> Contact email Dianne.Durand@CVSCaremark.com Dianne.Durand@CVSCaremark.com 142 <br /> Mail invoices to Facility <br /> Program record ( ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ j 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:U Date: u" �-�S <br /> — -- ----- �------------------ --------------- <br /> Accounting: Reviewed by: Date: *Ig ]S —Clerical: File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ---------------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1615-RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PREP; PR0519192 MELISSA NISSIM Active [ ] [ ] <br /> j2a,t,HMBP-Regular-Primary Location PR0539027 MICHAEL PARISSI Active [ ] <br /> 22 SM HW GEN<5 TONS/YR PRO522940 MICHELLE HENRY Active [ ] [ ] <br /> �2200-HAZARDOUS WASTE GENERATOR PROGRAM PR0539026 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532724 not assigned Inactive [ ] [ ] <br /> 6 q AwQ4.O PE ;o -Z 'j D <br />