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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 6/23/2016 <br />Submitted on: 6/20/2016 10:01:23AM <br />Submitted by: Ezekiel Robles Email: ezekiel.robles@psiusa.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: 8 <br />OW0017706 <br />JC Penney Corp. <br />6501 Legacy Drive <br />Plano, TX 75024 <br />972-431-1000 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0021534 <br />Facility name <br />JC PENNEY #2692 <br />Site address <br />2422 W Kettleman Ln <br />City <br />Lodi <br />ZIP code <br />95242 <br />Facility phone <br />209-367-1221 <br />Facility mailing address 4703 Tidewater Avenue, Suite B <br />Oakland, CA 94601 <br />BILLING INFORMATION <br />Contact name PSI <br />Address 4703 Tidewater Avenue, Suite B <br />Oakland, CA 94601 <br />Contact phone 510-434-9200 <br />Contact email frank.poss@psiusa.com <br />Mail invoices to Account <br />CERS ID: 10403185 <br />Facility ID in CERS: FA0021534 <br />Information after CIW processing CERS <br />(current submittal) field <br />JC Penney Corp. 111 <br />6501 Legacy Dr 113 <br />Plano, TX 75024 114, 115, 116 <br />9724311000 112 <br />JC PENNEY #2692 3 <br />2422 W Kettleman Ln 103 <br />Lodi 104 <br />95242 105 <br />2093671221 102 <br />4703 Tidewater Avenue, Suite B 108a <br />Oakland, CA 94601 108b, 108c, 108d <br />PSI 140 <br />4703 Tidewater Avenue, Suite B 143 <br />Oakland, CA 94601 144, 145, 146 <br />5104349200 141 <br />frank.poss@psiusa.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 lendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: Nf l2�I1V <br />fA <br />Accounting: Reviewed by: W Date: ���(,r �� 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 />2220 - SM HW GEN <5 TONS/YR PR0538438 ARIS VELOSO Active [ ] [ ] <br />V 1,021 - HMBP-Regular-Primary Location PR0539188 JAMIE LIMA Inactive <br />�ea�vka �Orl-krA�If � m PP11-01lu -N�t <br />wa(,+c � yes ('Iz1�s Mw'4�4s � <br />