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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 11/3/2015 <br /> Submitted on: 10126/2015 1:43:14PM CERS ID: 10646257 <br /> Submitted by: Ken Dobias Email: ken.dobias@questrmg.com Facility ID in CERS: incorrect <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 11 <br /> Owner ID OW0000531 <br /> Owner name DOLGEN CALIFORNIA, LLC Dolgen California, LLC 111 <br /> 100 Mission Ridge 113 <br /> Mailing address 100 MISSION RIDGE <br /> GOODLETTSVILLE, TN 37072 Goodlettsville, TN 37072 114, 115, 116 <br /> Work phone 615-855-4638 615-855-4024 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0023094 3 <br /> Facility name DOLLAR GENERAL STORE#15928 Dollar General# 15928 <br /> Site address 12984 E BLOSSOM CT 12984 Blossom Ct 103 <br /> City LOCKEFORD Lockeford 104 <br /> ZIP code 95237 95237 105 <br /> Facility phone 615-855-4781 209-727-2100 102 <br /> Facility mailing address 100 MISSION RIDGE 100 Mission Ridge 108a <br /> GOODLETTSVILLE, TN 37072 Goodlettsville, TN 37072 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name DOLLAR GENERAL STORE#15928 Eric Voyles 140 <br /> Address 100 MISSION RIDGE 100 Mission Ridge 143 <br /> GOODLETTSVILLE, TN 37072 Goodlettsville, TN 37072 144, 145, 146 <br /> Contact phone Not Specified 615-855-4024 141 <br /> Contact email wmanagem@dollargeneral.com 142 <br /> Mail invoices to Fac/ ty k S1 o <br /> Program record [ ] HMBP 44SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created j ] Tiered permit j ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: ",/C—U0 is <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year _�] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: + ►'N Date: 0- ' , t----- ----------------------------------- -------- --- <br /> Accounting: <br /> —_ —` —Accounting: Reviewed by: LJ Date: I I 3 15 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> By. ---- Date: <br /> 'ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1618-RETAIL MKT>2000 SQ FT (PREPKGD/LTD PREP) PR0540417 JEFFREY WONG Active I i I I <br />