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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/27/2015 <br /> Submitted on: 4/17/2015 1:36:45PM CERS ID: 10146189 <br /> Submitted by: Elizabeth Campos Email: ecampos@3ecompany.com Facility ID in CERS: FA0010273 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0008273 <br /> Owner name COSTCO WHOLESALE CORP Costco Wholesale Corporation 111 <br /> Mailing address PO BOX 35005 999 Lake Drive 113 <br /> SEATTLE, WA 981243405 Issaquah,WA 98027 114, 115, 116 <br /> Work phone 425-313-8100 (425) 313-8100 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010273 <br /> Facility name COSTCO WHOLESALE - MEATS#210 Costco Wholesale#210 3 <br /> Site address 17880 W SCHULTE RD 17880 W Schulte Rd 103 <br /> City TRACY Tracy 104 <br /> ZIP code 95376 95377 105 <br /> Facility phone 209-833-9124 (209) 221-6200 102 <br /> Facility mailing address PO BOX 35005 Costco Wholesale Attn: Licensing, PO Bc 108a <br /> SEATTLE, WA 981243405 Seattle,WA 98124-3405 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name COSTCO WHOLESALE-MEATS#210 Costco Wholesale Attn: Licensing 140 <br /> Address PO BOX 35005 P.O. Box 35005 143 <br /> SEATTLE, WA 981243405 Seattle, WA 98124-3405 144, 145, 146 <br /> Contact phone Not Specified (425) 313-6275 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG 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 /> y� <br /> Processed through CERS Integration Wizard by: ! ' ' ` Date: (.� <br /> --------------------- ------ ------------ - ----- - - <br /> Accounting: Reviewed by: �_Date. �S//S 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 /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMBP-Regular-Primary Location PR0512561 MICHAEL PARISSI Active [ ] [ ] <br /> 1963-CaIARP PROGRAM 3 FACILITY PRO527108 RAYMOND VON FLUE Active [ ] [ ] <br /> 1995-CaIARP FAC STATE SURCHARGE FEE PR0518946 HAZ MAT SJC DES Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0514265 MICHELLE HENRY Active [ ] [ ] <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO536367 MICHELLE HENRY Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO520193 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2332-EXEMPT TANK FACILITY PRO524020 THUY TRAN Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510273 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534373 not assigned Inactive [ ] [ ] <br />