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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 3/31/2015 <br /> Submitted on: 3/30/2015 9:02:32AM CERS ID: 10184311 <br /> Submitted by: Allen Faass Email: afaass@mygoodsmarket.com Facility ID in CERS: FA0012628 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0009827 <br /> Owner name Convenience Retailer LLC Convenience Retailer LLC 111 <br /> Mailing address 7108 KOLL CENTER PKWY STE 100 7108 KOLL CENTER PKWY STE 100 113 <br /> PLEASANTON, CA 94566 PLEASANTON, CA 94566 114, 115, 116 <br /> Work phone 925-884-0800 925-884-0800 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012628 <br /> Facility name C STOP#5449 C STOP#5449 3 <br /> Site address 322 S CENTER ST 322 S CENTER ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95203 95203 105 <br /> Facility phone 925-884-0800 925-884-0800 <br /> 102 <br /> Facility mailing address PO BOX 11537 7108 KOLL CENTER PKWY STE 100 108a <br /> PLEASANTON, CA 94588 PLEASANTON, CA 94566 108b,108c,load <br /> BILLING INFORMATION <br /> Contact name CONVENIENCE RETAILERS LLC Permit/Licenses 140 <br /> Address PO BOX 11537 PO Box 11537 143 <br /> PLEASANTON, CA 94588 PLEASANTON, CA 94588 144, 145. 146 <br /> Contact phone 925-884-0800 925-884-0800 141 <br /> Contact email APHeIp@mygoodsmarket.com APHeIp@mygoodsmarket.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 [ j 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:0—Date: `�r'� k-%< <br /> -------------------------------------------------- <br /> Accounting: Reviewed by: $1 � Date: F I Lt 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 PR0521126 ROBERT LOPEZ Active [ I [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO518491 STACY RIVERA Active [ ] [ ] <br /> 2361 -UST FACILITY PRO516472 STACY RIVERA Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0518177 MICHAEL KITH Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533735 not assigned Inactive [ ] [ ] <br />