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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/6/2017 <br /> Submitted on: 3/15/2017 12:55:45PM CERS ID: 10419805 <br /> Submitted by: Micah Thompson Email: micah.thompson@advance-auto.com Facility ID in CERS: FA0016193 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0013089 <br /> Owner name Golden State Supply LLC Golden State Supply LLC 111 <br /> Mailing address PO Box 2710 PO Box 26006 113 <br /> ROANOKE, VA 24001-2710 Raleigh, NC 27611 114, 115, 116 <br /> Work phone 919-573-3445 919-573-3445 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016193 <br /> Facility name CQ of Stockton #7015 CQ of Stockton #7015 3 <br /> Site address 1645 E Miner Ave 1645 E Miner Ave 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone 209-943-1000 209-943-1000 102 <br /> Facility mailing address PO Box 2710 5008 Airport Road 108a <br /> ROANOKE, VA 24001 Roanok,VA 24012 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name Elizabeth Dillon Micah Thompson 140 <br /> Address PO Box 2710 5008 Airport Road 143 <br /> ROANOKE, VA 24001-2710 Roanoke,VA 24012 144, 145, 146 <br /> Contact phone 919-573-3445 540-561-8492 141 <br /> Contact email elizabeth.dillon@carquest.com micah.thompson@advance-auto.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ I 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: D®r) Date: 7 <br /> I -- -- --- -- - ----------- - - -- - <br /> Accounting: Reviewed by: Date: Ckb 3 h 7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> - - ---- -- - -- --- - -- - - - <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMBP-Regular-Primary Location 1 chem units PRO524102 ROBERT LOPEZ Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PRO539759 PAULINE MANGRAI Active [ ] [ ] <br />