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SAN JOAQU,_ .;OUNTY ENVIRONMENTAL HEALTI _ DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/15/2015 <br />Submitted on: 12/31/2014 9:28:25AM <br />Submitted by: Elizabeth Campos Email: ecampos@3ecompany.com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />OW0001014 <br />Walgreen Co. <br />200 Wilmot Road <br />Deerfield, IL 60015 <br />847-914-2264 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0013341 <br />Facility name <br />Walgreens #15398 <br />Site address <br />660 W March Ln <br />City <br />Stockton <br />ZIP code <br />95207 <br />Facility phone <br />209-478-0891 <br />Facility mailing address 3207 Grey Hawk Ct Ste 200 <br />Carlsbad, CA 92010 <br />BILLING INFORMATION <br />Contact name Walgreens #15398 <br />Address 3207 Grey Hawk Ct Ste 200 <br />Carlsbad, CA 92010 <br />Contact phone 760-602-8700 <br />Contact email regulatory@3ecompany.com <br />Mail invoices to Facility <br />CERS ID: 10415479 <br />Facility ID in CERS: FA0013341 <br />Information after CIW processing CERS <br />(current submittal) field <br />Walgreen Co. 111 <br />200 Wilmot Rd. 113 <br />Deerfield, IL 60015 114, 115, 116 <br />(847) 914-2264 112 <br />Walgreens #15398 <br />3 <br />660 W March Ln <br />103 <br />Stockton <br />104 <br />95207 <br />105 <br />(209) 478-0891 <br />102 <br />3E Company/ Regulatory Department, 321 108a <br />Carlsbad, CA 92010 108b, 108c, 1o8d <br />3E Company, Regulatory Department/Wal 140 <br />3207 Grey Hawk Ct., Suite 200 143 <br />Carlsbad, CA 92010 144, 145, 146 <br />(760) 602-8700 141 <br />regulatory@3ecompany.com 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST <br />New PR#: _ <br />New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate <br />,this <br />,Icalendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard bDate: <br />Accounting: Reviewed by: 116 Date: 14Z1,0%1S 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 In i ed <br />1921 - HMBP-Regular-Primary Location PR0538633 HAZ MAT SJC OES Active [ ] <br />2220 - SM HW GEN <5 TONS/YR PR0538453 MICHELLE HENRY Active [ ] [ ] <br />