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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 1/6/2015 <br /> Submitted on: 1/5/2015 9:56:30AM CERS ID: 10182659 <br /> Submitted by: Susan Beers Email: susan.beers@hdsupply.com Facility ID in CERS: FA0009403 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0007403 <br /> Owner name HD SUPPLY WATERWORKS LTD HD SUPPLY WATERWORKS LTD 111 <br /> Mailing address 1625 S STOCKTON ST 3100 Cumberland Blvd, Ste 1700-MS1226 113 <br /> LODI, CA 95240 Atlanta, GA 30339 114, 115, 11E <br /> Work phone 209-334-9768 770-852-9000 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009403 <br /> Facility name HD SUPPLY WATERWORKS LTD HD SUPPLY WATERWORKS LTD 3 <br /> Site address 1615 S STOCKTON ST 1615 S STOCKTON ST 103 <br /> City LODI 104 <br /> ZIP code 95240 95240 105 <br /> Facility phone 209-334-9768 (209) 334-9768 102 <br /> Facility mailing address 1625 S STOCKTON ST LODI 1615 S STOCKTON ST 108a <br /> LODI, CA 95240 LODI, CA 95240 108b,1080,10E <br /> BILLING INFORMATION <br /> Contact name HD SUPPLY WATERWORKS LTD John Buck 140 <br /> Address 1625 S STOCKTON ST 501 W.Church Street 143 <br /> LODI, CA 95240 Orlando, FL 32805 144, 145, 14E <br /> Contact phone Not Specified 407-852-2360 141 <br /> Contact email john.buck@hdsupply.com 142 <br /> Mail invoices to €4eiB4y fl <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: /U-T Date: 11/.l is <br /> Accounting: Reviewed by: _ t6 Date: I 1 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 /> 1921 -HMBP-Regular-Primary Location PR0520993 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0513818 ARIS VELOSO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509403 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533739 not assigned Inactive [ ] [ ] <br />