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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 8/16/2018 <br />Submitted on: 6/22/2018 1:19:52PM <br />Submitted by: Joe Scholl Email: jscholl@tractorsupply.com <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 />OW0020036 <br />Tractor Supply Company <br />5401 Virginia Way <br />Brentwood, TN 37027 <br />615-440-4660 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0022513 <br />Facility name <br />Tractor Supply Store #1303 <br />Site address <br />860 N JACK TONE RD <br />City <br />Ripon <br />ZIP code <br />95366 <br />Facility phone <br />615-440-4600 <br />Facility mailing address 5401 Virginia Way <br />Brentwood, TN 37027 <br />BILLING INFORMATION <br />Contact name Brian Spears <br />Address 5401 Virginia Way <br />Brentwood, TN 37027 <br />Contact phone 615-440-4115 <br />Contact email bspears@tractorsupply.com <br />Mail invoices to Account <br />CERS ID: 10453774 <br />Facility ID in CERS: FA0022513 <br />Information after CIW processing CERS <br />(current submittal) field <br />Tractor Supply Company 111 <br />5401 Virginia Way 113 <br />Brentwood, TN 37027 114, 115, 116 <br />615-440-4000 112 <br />Tractor Supply Store #1303 -Ripon 3 <br />860 N Jack Tone Rd 103 <br />Ripon 104 <br />95366 105 <br />209-599-1150 102 <br />5401 Virginia Way 108a <br />Brentwood, TN 37027 108b, 108c, 108d <br />Joe Scholl 140 <br />5401 Virginia Way 143 <br />Brentwood, TN 37027 144, 145, 146 <br />615-440-4307 141 <br />hazmat@tractorsupply.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 />Processed through CERS Integration Wizard byDate: <br />Accounting: Reviewed by: _ G6 Date: g �1 l Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ �/Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />2220 - SM HW GEN <5 TONS/YR PR0539379 ELIANNA FLORIDO Active [ ] [ ] <br />1920 - HMBP-Common Materials 2 chem units PR0539380 NICHOLAS LOEHRER Inactive i�4,✓� [ ] <br />2V0 --i WV ,k e..� i i�- 1� L� �� �� r 4 4AL MAktA\ <br />