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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/11/2014 Submitted on: 5/19/2014 11:52:53AM CERS ID: 10440307 Submitted by: Janelle Brown Email:jbrown@kendallcompliance.com Facility ID in CERS: FA0003183 Information prior to CIW processing Information after CIW processing CERS OWNER INFORMATION (current EC database) (current submittal) field Owner ID OW0010964 Owner name 99 CENTS ONLY STORES 99 Cents Only Stores 111 Mailing address 4000 UNION PACIFIC AVE 4000 Union Pacific Avenue 113 COMMERCE, CA 90023 Commerce, CA 90023 114, 115, 116 Work phone (323) 980-8149 112 FACILITY FILE INFORMATION Facility ID FA0003183 Facility name 99 CENTS ONLY STORES#185 99 Cents Only Stores#185 3 Site address 1320 W 11TH ST 1320 W 11th St 103 City TRACY Tracy 104 Zip code 95376 95376 105 Facility phone 209-839-9619 (209) 839-9619 102 Facility mailing address 4000 E UNION PACIFIC AVE 4000 Union Pacific Avenue 108a COMMERCE, CA 90023 Commerce, CA 90023 108b. 108a 108d BILLING INFORMATION Contact name 99 CENTS ONLY STORES#185 Paul Dolby. 140 Address 4000 E UNION PACIFIC AVE 4000 Union Pacific Avenue 143 COMMERCE, CA 90023 Commerce, CA 90023 144, 145, 146 Contact phone 209-839-9619 Aa@ii)980-8145 ext 1987 141 Contact email 4kwr.Dolby@99only.com 142 Mail invoices to Facility Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ j RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: Date: ------9-----Y--- — ------ --- Y--- --- ---- Accountin Reviewed by: Of Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] [ ] Surch ve ified B : Date: — d ed ---- — — ---------------------- ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 1618-RETAIL MKT>2000 SQ FT (PREPKGD 1 LTD PREP) PRO161629 MELISSA NISSIM Active -[ I I j 2220-SM HW GEN<5 TONS/YR PRO538450 MICHELLE HENRY Active I ] I ]