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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run 8/1412014 <br /> Submitted on: 5/1912014 11:06:53AM CERS ID: 10440301 <br /> Submitted by: Janelle Brown Email jbrown@kendallcompliance.com Facility ID in CERS: FA0000917 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> (current EC database) (current submittal) field <br /> OWNER INFORMATION <br /> Owner ID OW0010964 111 <br /> Owner name 99 CENTS ONLY STORES 99 Cents Only Stores <br /> 4000 Union PacificAvenue 113 <br /> Mailing address 4000 UNION PACIFIC AVE <br /> COMMERCE, CA 90023 Commerce, CA 90023 114, 115, 116 <br /> Work phone Not Specified (323) 980-8145 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000917 <br /> Facility name 99 CENTS ONLY STORES#157 99 Cents Only Stores#157 3 <br /> Site address 300 W KETTLEMAN LN 300 W Kettleman Ln 103 <br /> City LODI Lodi 104 <br /> Zip code 95240 95240 105 <br /> Facility phone Not Specified (209) 339-9103 102 <br /> Facility mailing address 4000 E UNION PACIFIC AVE 4000 Union PacificAvenue 108a <br /> COMMERCE, CA 90023 Commerce, CA 90023 108b, 108c,told <br /> BILLING INFORMATION <br /> Contact name 99 CENTS ONLY STORES#157 Paul Dolby 140 <br /> Address 4000 E UNION PACIFIC AVE 4000 Union Pacific Avenue 143 <br /> COMMERCE, CA 90023 Commerce, CA 90023 144, 145, 146 <br /> Contact phone 213-251-2200 (323) 980-8145 ext 1987 141 <br /> Contact email Pau1.Dol by@99only.corn 142 <br /> Mail invoices to Facility_ <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ CRA.,. HW New PR#: b% <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: tG11- <br /> Assigned to: "5N <br /> Please bill: full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by. Date: _���✓ Clerical: [ ] File [ ] Relabel file Create new file <br /> Acct billed 4- --SufGharge vedfied By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1618-RETAIL MKT>2000 SQ FT (PREPKGD I LTD PREP) PRO160320 NICHOLAS WIESEMAN Active [ ] [ <br /> 2220-SM HW GEN<5 TONS/YR PR0538452 MICHELLE HENRY Active [ ] [ <br /> 9�LA, CA CAA'G'�5 <br />