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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to TY <br /> by CERS Integration Wizard <br /> Submitted on: 8/30/2013 1:45:21 PM CERS 104548Date run: 7/4548 4 <br /> Submitted by: Crystalyn Alford Email: calford@3ecompany.com 84 <br /> Facility ID in CERS: <br /> : FA0021338 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0017599 <br /> Owner name WALGREEN CO Walgreen Co. <br /> Mailing address PO Box 9904 200 Wilmot Road 111 <br /> DEERFIELD, IL 60015 Deerfield, IL 60015 114, 1153116 <br /> Work phone (847) 914-2264 <br /> 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021338 <br /> Facility name WALGREENS#09723 Walgreens#9723 <br /> Site address 3131 W HAMMER LN 3131 W Hammer Ln 3 <br /> City STOCKTON Stockton 103 <br /> Zip code 95209 104 <br /> 95209 <br /> Facility phone 847-527-4439 9520105 <br /> 476-8819 <br /> 102 <br /> Facility mailing address PO BOX 901 <br /> 3E Company, Regulatory Dept/Walgreen, 3: 108a <br /> DEERFIELD, IL 60015 Carlsbad, CA 92010 108b,1080,108d <br /> BILLING INFORMATION <br /> Contact name WALGREENS#09723 3E Company, Regulatory Dept/Walgreens 140 <br /> Address PO BOX 901 3207 Grey Hawk Court, Suite 200 143 <br /> DEERFIELD, IL 60015 Carlsbad, CA 92010 144, 145, 146 <br /> Contact phone Not Specified (760) 602-8700 141 <br /> Contact email <br /> Mail invoices to Facility regulatory@3ecompany.com 142 <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendarear <br /> y [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> --- ----- <br /> Accounting: Reviewed by:_ Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] billed [ ] Surc ge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> m Element and Description Record ID Employee name Status Reactivated Inactivated <br /> -RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PREP PR0537169 NICHOLAS WIESEMAN Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO538448 MICHELLE HENRY Active [ ] [ ] <br /> 4557-MED WASTE LIMITED HAULER PR0537368 ROBERT MCCLELLON Active [ ] [ ] <br />