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SAN JOAQW' I COUNTY ENVIRONMENTAL HEALT . EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 419/2015 <br /> Submitted on: 3/26/2015 8:42:44AM CERS ID: 10184937 <br /> Submitted by: Eric Ensminger Email: eensming@3ecompany.com Facility ID in CERS: FA0015387 <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. Longs Drug Stores California, 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) 770-3315 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015387 <br /> Facility name CVS Pharmacy#9830 CVS Pharmacy#9830 3 <br /> Site address 6632 PACIFIC AVE 6632 Pacific Ave 103 <br /> City STOCKTON Stockton 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-951-6544 (209) 951-6544 102 <br /> Facility mailing address CVS Caremark, Attn: Dianne E. Durand, 1 C CVS Health, Attn: Dianne E. Durand, Licei 108a <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name CVS Caremark, Attn: Dianne E. Durand CVS Health,Attn: Dianne E. Durand, Lice 140 <br /> Address 1 CVS Drive-23062A One CVS Drive—MC23062A 143 <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 144, 145, 146 <br /> Contact phone 401-770-3315 (401) 770-3315 141 <br /> Contact email Dianne.Durand@CVSCaremark.com Dianne,Durand@CVSCaremark.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: W" Date: Lf ' a"t <br /> Accounting: Reviewed by: t6 Date: �j/�/� 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) PRO522583 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO539036 HAZA SAEED Active <br /> 2240-RCRAACUTELY HW GEN<5 TONS/YR PR0536194 MICHELLE HENRY Active [ ] [ ] <br /> 2200-HAZARDOUS WASTE GENERATOR PROGRAM PR0539035 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0536195 MICHELLE HENRY Inactive [ ] [ ] <br />