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E- SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/13/2015 <br /> Submitted on: 12/23/2014 5:11:48PM CERS ID: 10182333 <br /> Submitted by: Lyazzat Segizbayeva Email: Isegizbayeva@3ecompany.com Facility ID in CERS: FA0008046 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001014 <br /> Owner name Walgreen Co. Walgreen Co. 111 <br /> Mailing address 200 Wilmot Road 200 Wilmot Road 113 <br /> Deerfield, IL 60015 Deerfield, IL 60015 114, 115, 116 <br /> Work phone 847-914-2264 (847)914-2264 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0008046 <br /> Facility name WALGREENS#02770 WALGREENS#02770 3 <br /> Site address 7929 LOWER SACRAMENTO RD 7929 LOWER SACRAMENTO RD 103 <br /> City Stockton STOCKTON 104 <br /> ZIP code 95210 95210 105 <br /> Facility phone 209-474-0880 (209)474-0880 102 <br /> Facility mailing address 3207 Grey Hawk Court, Suite 200 3E Company, Reg.Dept./Walgreen Co., 3 108a <br /> CARLSBAD, CA 92010 CARLSBAD, CA 92010 108b,10aC,load <br /> BILLING INFORMATION <br /> Contact name 3E Company, Regulatory Dept/Walgreen Cc 3E Company, Regulatory Dept/Walgreen Cc 140 <br /> Address 3207 Grey Hawk Court, Suite 200 3207 Grey Hawk Court, Suite 200 143 <br /> CARLSBAD, CA 92010 CARLSBAD, CA 92010 144, 145, 146 <br /> Contact phone 760-602-8700 (760)602-8700 141 <br /> Contact email reguWory@3ecompany.com regulatory@3ecompany.com 142 <br /> Mail invoices to Factlity A <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: Date: ( ]3 ` 7 <br /> ---- ------------------- <br /> Accounting: Reviewed by: �J Date: t���✓ I 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 /> 1618-RETAIL MKT>2000 SO FT (PREPKGD/LTD PREP) PR0508371 NICHOLAS WIESEMAN Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0538630 HAZA SAEED Active [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0535451 MICHELLE HENRY Active [ ] [ ] <br /> 4557-MED WASTE LIMITED HAULER PR0536048 ROBERT MCCLELLON Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0536010 not assigned Inactive <br />