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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 11/6/2014 <br /> 4298 <br /> Submitted on: 9/9/2014 7:40:47AM CERS ID: ID in CERS: <br /> Submitted by: Stephanie Fleischer Email: sfleischer@3ecompany.com Facility D n CE <br /> Information prior to CIW processing Information after CIW processing CERS <br /> (current EC database) (current submittal) field <br /> OWNER INFORMATION <br /> Owner ID OW0020086 111 <br /> Owner name Costco Wholesale Corporation Costco <br /> oLakee Wholesale Corporation ive 113 <br /> Mailing address 999 Lake Drive 999 Issaquah, WA 98027 11a, 115,11E <br /> Issaquah, WA 98027 q <br /> Work phone 425-313-8100 (425) 313-8100 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022539 3 <br /> Facility name Costco Depot#725 Costco Depot#725 <br /> 103 <br /> Site address 25149 S SCHULTE RD 25149 S. Schulte Rd. 104 <br /> City Tracy Tracy <br /> Zip code 95377 95377 105 <br /> Facility phone 209-221-8400 (209) 221-8400 102 <br /> Facility mailing address P.O. Box 35005 Costco Wholesale Attn: Licensing, P.O. Box 108a <br /> Seattle, WA 98124-3405 Seattle, WA 98124-3405 108b,108c,10E <br /> BILLING INFORMATION <br /> Contact name Costco Wholesale#725 Costco Wholesale Attn: Licensing 140 <br /> Address PO Box 35005 P.O. Box 35005 143 <br /> Seattle, WA 98027 Seattle, WA 98124-3405 144, 145,14E <br /> Contact phone 425-313-6275 (425) 313-6275 141 <br /> Contact email 142 <br /> Mail invoices to F,aeility <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 calendar year [ ] exempt from billing <br /> Processed through CERS IntegrationWizardby: WT Date: Idf 6! ILI <br /> Accounting: Reviewed by: P� Date: I[ tf Clerical: [ ] File [ ] Relabel file [ J Create new file <br /> [ ] Acc ' ed [ ] Surc a v"(rifledv"( By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMBP-Regular-Primary Location PR0539433 MICHAEL PARISSI Active [ ] [ 1 <br /> 2220-SM HW GEN<5 TONSNR PRO539432 THUY TRAN Active ( ] [ ] <br />