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SAN JOAQUITCOUNTY ENVIRONMENTAL HEALT"EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 2/4/2015 <br /> Submitted on: 1/12/2015 4:05:34PM CERS ID: 10187409 <br /> Submitted by: Eric Ensminger Email: eensming@3ecompany.com Facility ID in CERS: FA0019897 <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. Garfield Beach CVS, 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 FA0019897 <br /> Facility name CVS Pharmacy#5403 CVS Pharmacy#5403 3 <br /> Site address 1175 W LATHROP RD 1175 W Lathrop Rd 103 <br /> City MANTECA Manteca 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 209-825-4685 (209) 825-4685 102 <br /> Facility mailing address 1 CVS DR 23062A CVS Health, Attn: Dianne E. Durand, Lice 108a <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name CVS Pharmacy#5403 CVS Health, Attn: Dianne E. Durand, Lice 140 <br /> Address 1 CVS DR 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.Du rand@CVSCaremark.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] 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: \,kA Date: �-'L4'1 <br /> --------------------------------------------------- <br /> Accounting: Reviewed by: L427 Date: :2&1/5' Clerical: N 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 /> 1618-RETAIL MKT>2000 So FT (PREPKGD/LTD PREP) PRO530691 LISA MEDINA Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO539324 MICHAEL PARISSI Active [ ] <br /> 2240-RCRAACUTELY HW GEN<5 TONS/YR PR0531041 MICHELLE HENRY Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531914 not assigned Inactive [ ] [ ] <br /> V oU - �r �tP3o�o <br /> o�-c-- <br />