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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 5/11/2015 <br /> Submitted on: 5/1/2015 3:12:17PM CERS ID: 10165777 <br /> Submitted by: Nicole Magner Email: Nicole.magner@belshire.com Facility ID in CERS: FA0007461 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000721 <br /> Owner name 7-ELEVEN INC. 7-ELEVEN INC 111 <br /> Mailing address 1722 ROUTH STREET P.O. BOX 711,ATTN: ENVIRONMENTAL C 113 <br /> DALLAS, TX 75201 DALLAS, TX 75221 114, 115, 116 <br /> Work phone 972-828-6586 800-828-0711 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007461 <br /> Facility name 7-ELEVEN INC#14113 7-ELEVEN INC#14113 3 <br /> Site address 3040 W BENJAMIN HOLT DR 3040 West Benjamin Holt Drive 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95219 95219 105 <br /> Facility phone 209-478-3040 209-478-3040 <br /> 102 <br /> Facility mailing address P.O. BOX 711, ATTN: ENVIRONMENTAL D P.O. BOX 711, ATTN: ENVIRONMENTAL D 108a <br /> DALLAS, TX 75221 DALLAS, TX 75221 108b,108c,toad <br /> BILLING INFORMATION <br /> Contact name 7-ELEVEN INC 7-ELEVEN INC 140 <br /> Address P.O. BOX 711, ATTN: ENVIRONMENTAL D P.O. BOX 711, ATTN: ENVIRONMENTAL D 143 <br /> DALLAS, TX 75221 DALLAS, TX 75221 144, 145, 146 <br /> Contact phone 800-828-0711 800-828-0711 141 <br /> Contact email STEPHEN.BOYD@7-11.COM STEPHEN.BOYD@7-11.COM 142 <br /> Mail invoices to Account <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 /> • i <br /> Processed through CERS Integration Wizard by: `" Date: <br /> -------------- ----- <br /> --------------------------- - <br /> Accounting: Reviewed by: I/I"J Date: /3 7 Clerical: [ ] File [ ] Relabel file ( ] Create new file <br /> [ ] Acct eaSurcharge 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 PR0521190 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0531101 FATINAH ZAREEF Active [ ] [ ] <br /> 2351 -UST FACILITY-2481 COMPLIANT PR0506497 FATINAH ZAREEF Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0506742 MICHAEL KITH Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533570 not assigned Inactive <br />