Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />BILLING INFORMATION <br />Contact name CVS Pharmacy #3908 <br />Changes to EnvisionConnect by CERS Integration Wizard <br />140 <br />Address ONE CVS DR MAIL DROP 23062A <br />One CVS Drive — MC23062A <br />Date run: <br />4f2/2015 <br />1112015 2:24:31 PM <br />Submitted on:t.sminger <br />144, 145, 146 <br />Contact phone Not Specified <br />(401) 770-3315 <br />141 <br />CERS ID: 10184615 <br />Submitted by: Eric Email: ee seting@3ecompany.com <br />Facility ID in CERS: <br />FA0014350 <br />2200 - HAZARDOUS WASTE GENERATOR PROGRAM <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Owner ID <br />OW0016236 <br />Please bill: [) full calendar year [ ] prorate this calendar year <br />Owner name <br />Mailing address <br />Longs Drug Stores California, L.L.C. <br />One CVS Drive <br />Longs Drug Stores California, L.L.C. <br />111 <br />Accounting: Reviewed by: Date:�g ! Clerical: File [ ] Relabel file [) Create <br />Woonsocket, RI 02895 <br />One CVS Drive <br />Woonsocket, RI 02895 <br />113 <br />114, 115, 116 <br />Work phone <br />401-765-1500 <br />(401) 765-1500 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0014350 <br />Facility name <br />CVS Pharmacy #3908 <br />CVS Pharmacy #3908 <br />3 <br />Site address <br />1885 W 11th St <br />1885 W 11th St <br />103 <br />City <br />Tracy <br />Tracy <br />104 <br />ZIP code <br />95376 <br />95376 <br />105 <br />Facility phone <br />209-836-1460 <br />(209) 836-1460 <br />102 <br />Facility mailing address <br />ONE CVS DR MAIL DROP 23062A <br />CVS Health, Attn: Dianne E. Durand, Lice <br />108a <br />Woonsocket, RI 02895 <br />Woonsocket, RI 02895 <br />108b. 108c, 108d <br />BILLING INFORMATION <br />Contact name CVS Pharmacy #3908 <br />CVS Health, Attn: Dianne E. Durand, Lice <br />140 <br />Address ONE CVS DR MAIL DROP 23062A <br />One CVS Drive — MC23062A <br />143 <br />Woonsocket, RI 02895 <br />Woonsocket, RI 02895 <br />144, 145, 146 <br />Contact phone Not Specified <br />(401) 770-3315 <br />141 <br />Contact email Dianne. Durand@CVSCaremark.com <br />Dianne.Durand@CVSCaremark.com <br />142 <br />Mail invoices to Facility <br />2200 - HAZARDOUS WASTE GENERATOR PROGRAM <br />PR0539026 <br />Program record [ ] HMBP [ ] SQG HW [) LQG HW j) <br />RCRA HW New PR#: <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ <br />] UST New PE: <br />Inactive <br />( 4 AJ 16,C -o PC ;v q:]-'J'D <br />Assigned to: <br />Please bill: [) full calendar year [ ] prorate this calendar year <br />[ ] calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: k AA Date: <br />kknext <br />�)-' K <br />Accounting: Reviewed by: Date:�g ! Clerical: File [ ] Relabel file [) Create <br />new file <br />j ] Acct billed [ ] Surcharge verified <br />By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1615 - RETAIL MKT 301-2000 SQ FT (PREPKGDILTD PREP; <br />PR0519192 <br />MELISSA NISSIM <br />Active (] [ ] <br />1HMBP-Regular-Primary Location <br />PR0539027 <br />MICHAEL PARISSI <br />Active j ] <br />22 SM HW GEN <5 TONS/YR <br />PR0522840 <br />MICHELLE HENRY <br />Active [ ] [ ] <br />2200 - HAZARDOUS WASTE GENERATOR PROGRAM <br />PR0539026 <br />HAZ MAT SJC OES <br />Inactive <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0532724 <br />not assigned <br />Inactive <br />( 4 AJ 16,C -o PC ;v q:]-'J'D <br />