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SAN JOAQUI*tOUNTY ENVIRONMENTAL HEALTHI?EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 8/11/2014 <br /> Submitted on: 1/24/2014 6:27:57AM CERS ID: 10187409 <br /> Submitted by: Stephanie Fleischer Email: sfleischer@3ecompany.com Facility ID in CERS: FA0019897 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (ctmenEsup ittal) field <br /> Owner ID OW0016236 <br /> Owner name Longs Drug Stores California, L.L.C. C(405-1500 <br /> ach CVS, L.L.C. 111 <br /> Mailing address 1 CVS Drive 113 <br /> Woonsocket, RI 02895 t, RI 02895 114, 115,116 <br /> Work phone 401-770-3315 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 209-566-5875 (209) 825-4685 102 <br /> Facility mailing address ONE CVS DR MAIL DROP 23062A CVS Caremark, Attn: Dianne E. Durand, 1 C 108a <br /> WOONSOCKET, RI 02895 Woonsocket, RI 02895 10eb,108c,108d <br /> BILLING INFORMATION <br /> Contact name CVS/PHARMACY#5403 rCVS <br /> , Attn: Dianne E. Duran 140 <br /> Address ONE CVS DR MAIL DROP 23062A3062A 143 <br /> WOONSOCKET, RI 02895 I 02895 144, 145, 146 <br /> Contact phone 401-770-2272 141 <br /> Contact email @CVSCaremark.com 142 <br /> Mail invoices to Facility <br /> Program recordyi <br /> HMBP [ ] SQG HW [ ] LQG HW [ ] W N S393Z <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: pA'R-LSS l <br /> Please bill: full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: (V Date: Q'I <br /> --——— — --------- ---- — - <br /> Accounting: Reviewed by: � Date: l 1 Clerical: File [ ] Relabel file ki"Create new file <br /> ]NlLoo [LrAcct billed— By <br /> ----- ------ --- . --- 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-TD PREP) PR0530691 LISA MEDINA Active [ ] [ ] <br /> T SM HW GEN<5 TONS/YR PR0531041 MICHELLE HENRY Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531914 not assigned Inactive [ J [ ] <br />