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1: SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/18/2014 <br /> Submitted on: 5/30/2014 12:36:06PM CERS ID: 10166191 <br /> Submitted by: Nicole Long Email: Nicole.long@belshire.com <br /> Facility ID in CERS: FA0001817 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0018159 <br /> Owner name 7-ELEVEN INC 7-ELEVEN INC 111 <br /> Mailing address PO BOX 711, ATTN: ENVIRONMENTAL DE PO BOX 711, ATTN: ENVIRONMENTAL DE 113 <br /> DALLAS, TX 75221 DALLAS, TX 75221 114, 115, 116 <br /> Work phone 800-828-0711 800-828-0711 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001817 <br /> Facility name 7-ELEVEN INC#35355 7-ELEVEN INC#35355 3 <br /> Site address 3202 W Hammer Ln 3202 W Hammer Ln 103 <br /> City Stockton Stockton 104 <br /> Zip code 95209 95209 105 <br /> Facility phone 209-957-2900 209-957-2900 102 <br /> Facility mailing address PO BOX 711, ATTN: ENVIRONMENTAL DE PO BOX 711, ATTN: ENVIRONMENTAL DE 108a <br /> DALLAS, TX 75221 DALLAS, TX 75221 108b,108c,toed <br /> BILLING INFORMATION <br /> Contact name 7-ELEVEN INC 7-ELEVEN INC 140 <br /> Address PO BOX 711, ATTN: ENVIRONMENTAL DE PO BOX 711, ATTN: ENVIRONMENTAL DE 143 <br /> DALLAS, TX 75221 DALLAS, TX 75221 144, 145, 146 <br /> Contact phone 800-828-0711 800-828-0711 141 <br /> Contact email STEPHEN.BOYD@7-11.COM STEPHEN.BOYD@7-11.COM 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRAHW New PR#: <br /> created [ ] Tiered permit [ ] APSA <br /> [ ] CaIARP [ ] 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: yv,�I" Date: VIS 4q <br /> --- --9. ----- — — — —B------ - — -- <br /> Accountin Reviewed by:_ —Date: Clerical: File [ ] Relabel file [ ] Create new file <br /> [ ] Acc ed [ ] Surch yen led y: Date: <br /> --- ----�-- ------------------ -- — <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1617-RETAIL MARKET>1000 SO FT W/FOOD PREP PR0160263 VIDAL PEDRAZA Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO519486 LOWELLALLEN Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0518105 GARRETT BACKUS Active [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PR0508186 MICHAEL KITH Inactive [ ] [ ] <br /> 2361 -UST FACILITY PRO231129 GARRETT BACKUS Active [ ] [ ) <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507284 MICHAEL KITH Inactive [ ] ( ] <br /> to <br />