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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />L- Changes to EnvisionConnect by CERS Integration Wizard <br />Submitted on: 12/23/2014 5:20:30PM Date run: 12/26/2014 <br />37 <br />Submitted b L azzat Segizbayeva Emait Isegizbayeva@3ecompany.com CERS ID: FA0002 74 <br />y� y Facility ID in CERS: FA0002974 <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />OW0001014 <br />Walgreen Co. <br />200 Wilmot Road <br />Deerfield, IL 60015 <br />847-914-2264 <br />FACILITY FILE INFORMATION <br />Information after CIW processing CERS <br />(current submittal) field <br />Walgreen Co. 111 <br />200 Wilmot Road 113 <br />Deerfield, IL 60015 114, 115, 11E <br />(847)914-2264 112 <br />Facility ID <br />FA0002974 <br />Employee name <br />Status <br />Facility name <br />WALGREENS 42434 <br />WALGREENS 42434 <br />Active <br />Site address <br />1830 W ELEVENTH ST <br />1830 W ELEVENTH ST <br />3 <br />City <br />Tracy <br />MICHELLE HENRY <br />103 <br />ZIP code <br />95376 <br />95376 <br />104 <br />Facility phone <br />209-832-1498 <br />(209) 832-1498 <br />105 <br />102 <br />Facility mailing address <br />3207 Grey Hawk Court, Suite 200 <br />TRACY 3E Company, Reg.Dept. / Walgreepoop., <br />CARLSBAD, CA 92010 <br />Carlsbad, CA 92010 <br />108b, 108c, 1 O <br />BILLING INFORMATION <br />Contact name <br />3E Company, Regulatory Dept[Walgreen Ce <br />3E Company, Regulatory Dept/Walgreen Ce <br />140 <br />Address <br />3207 Grey Hawk Court, Suite 200 <br />3207 Grey Hawk Court, Suite 200 <br />143 <br />Contact phone <br />CARLSBAD, CA 92010 <br />760-602-8700 <br />CARLSBAD, CA 92010 <br />144, 145, 14E <br />Contact email <br />regulatory@3ecompany.com <br />(760) 602-8700 <br />regulatory@3ecompany.com <br />141 <br />142 <br />Mail invoices to <br />Faei}ity <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />Please bill: [ ] full calendar year [ ] prorate this calendar year <br />Processed through CERS Integration Wizard by: Date <br />Accounting: <br />New PR#: _ <br />New PE: _ <br />Assigned to: <br />[ ] next calendar year [ ] exempt from billing <br />Reviewed by. _ f�� Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />_[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description <br />Record ID <br />Employee name <br />Status <br />1618 - RETAIL MKT >2000 SQ FT (PREPKGD I LTD PREP) <br />PRO163320 <br />MELISSA NISSIM <br />Active <br />1921 - HMBP-Regular-Primary Location <br />PR0538406 <br />MICHAEL PARISSI <br />Active <br />2220 - SM HW GEN <5 TONSIYR <br />PR0535514 <br />MICHELLE HENRY <br />Active <br />4557 - MED WASTE LIMITED HAULER <br />PR0536051 <br />ROBERT MCCLELLON <br />Inactive <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PRO535957 <br />not assigned <br />Inactive <br />Reactivated Inactivated <br />