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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 2/28/2018 <br /> Submitted on: 1117/2018 9:45:06AM CERS ID: 10749253 <br /> Submitted by: Erin Baltazar Email: ebaltazar@Verisk3e.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: 1 <br /> Owner ID OW0023074 <br /> Owner name Costco Wholesale Corporation Costco Wholesale Corporation 111 <br /> Mailing address 999 Lake Drive 999 Lake Drive 113 <br /> Issaquah, WA 98027 Issaquah, WA 98027 114, 115, 116 <br /> Work phone 425-313-8100 ]425) 313-8100 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0024496 <br /> Facility name Costco Wholesale#38 (Gas Station) Costco Wholesale#38 (Gas Station) 3 <br /> Site address 1630 E Hammer Ln 1630 E Hammer Ln 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95210 95210 105 <br /> Facility phone 209-478-2040 (209)478-2040 102 <br /> Facility mailing address Costco Licensing, P.O. Box 35005 Costco Licensing, P.O. Box 35005 108a <br /> Seattle, WA 98124-3405 Seattle, WA 98124-3405 108e, 108c,108d <br /> BILLING INFORMATION <br /> Contact name Costco Licensing Costco Licensing 140 <br /> Address P.O. Box 35005 P.O. Box 35005 143 <br /> Seattle, WA 98124-3405 Seattle, WA 98124-3405 144, 145, 146 <br /> Contact phone 425-313-6275 (425) 313-6275 141 <br /> Contact email Isimpson@costco.com Isimpson@costco.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: Date: ` % -� <br /> Accounting: Reviewed by. JA�? Date: 15 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> co Employee name Status Reactivated I a iv ted <br /> 1921 -HMBP-Regular-Primary Location 6 chem units Bj JAMIE LIMA Active [ <br /> 2220-SM HW GEN<5 TONSIYR (� PRO 2591 VICKI MCCARTNEY Activepel� [ ] <br /> vt <br /> 1-7 0-5 -ID q pq IWAI <br /> M �j <br />