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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run' 6/12/2014 <br /> Submitted on: 3/9/2014 12:19:30PM CERS ID: 10140597 <br /> Submitted by: Robyn West Email: robyn.west@searshc.com <br /> Facility ID in CERS: FA0003278 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0002315 <br /> Owner name Kmart Corporation Kmart Corporation 111 <br /> Mailing address 3333 Beverly Road, B5-348A 3333 Beverly Road, B5-348A 113 <br /> City Hoffman Estates Hoffman Estates 114 <br /> State IL IL <br /> ZIP code 60179 60179 11 1155 <br /> Work phone 847-286-0037 847-286-0037 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003278 <br /> Facility name Kmart#3174 Kmart#3174 3 <br /> Site address 2180 E Mariposa Rd 2180 E Mariposa Rd 103 <br /> City Stockton Stockton 104 <br /> Zip code 95205 95205 105 <br /> Facility phone 209-948-8205 209-948-8205 102 <br /> Facility mailing address 2180 E Mariposa Rd 2180 E Mariposa Rd 108a <br /> City Stockton Stockton 108b <br /> State CA CA 1080 <br /> Zip code 95205 95205 108d <br /> BILLING INFORMATION <br /> Contact name Robyn West Robyn West 140 <br /> Address 3333 Beverly Road, B5-348A 3333 Beverly Road, 65-348A 143 <br /> City Hoffman Estates Hoffman Estates 144 <br /> State IL IL 145 <br /> Zip code 60179 60179 146 <br /> Contact phone 847-286-0037 847-286-0037 141 <br /> Contact email robvrjwest@searshc.com robyn.west@searshc.com 142 <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG 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 calendarear <br /> / y [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: � Date: (p '11 -1 <br /> 9 Y Clerical• F[le [ ] Create new file <br /> --------------- <br /> ---------- <br /> Accountin Reviewed b : Date: <br /> --- — [ ] A l-- [ ] —ixc rgdl/en led 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 /> J1614-FOOD EST>1001 SQ FT W/O SEATING PRO161524 LEYNA HUYNH Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0520022 LOWELLALLEN Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0531067 MICHELLE HENRY Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512300 HAZ MAT SJC OES Inactive [ ] <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0502273 LETITIA BRIGGS Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510012 HAZ MAT SJC OES Inactive [ ] t ] <br /> 4740-WASTE TIRE SITE-EXEMPT PR0523647 HARPRIT MATTU Inactive [ ] ( ] <br />