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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 8/21/2017 <br /> Submitted on: 8/18/2017 10:29:31AM CERS ID: 10707490 <br /> Submitted by: Katherine Sorge Email: ksorge@kcgenviro.com Facility ID in CERS: FA0007860 <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: 2 <br /> Owner ID OW0005134 <br /> Owner name Office Depot, Inc. Office Depot, Inc. 111 <br /> Mailing address 6600 N. Military Trail 6600 N. Military Trail 113 <br /> Boca Raton, FL 33496 Boca Raton, FL 33496 114, 115, 116 <br /> Work phone 561-438-4800 (561)438-4800 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007860 <br /> Facility name OfficeMax#6573 OfficeMax#6573 3 <br /> Site address 3939 E Hammer Ln 3939 E Hammer Ln 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95212 95212 105 <br /> Facility phone 209-472-7002 (209)472-7002 102 <br /> Facility mailing address 3939 E Hammer Ln 3939 E Hammer Ln 108a <br /> Stockton, CA 95212 Stockton, CA 95212 108b, 10ec,coed <br /> BILLING INFORMATION <br /> Contact name Jacqueline Demoya Jacqueline Demoya 140 <br /> Address 6600 N. Military Trail C414S 6600 N. Military Trail C414S 143 <br /> Boca Raton, FL 33496 Boca Raton, FL 33496 144, 145, 146 <br /> Contact phone 561-438-0207 (561)438-0207 141 <br /> Contact email Jacqueline.Demoya@officedepot.com Jacqueline.Demoya@officedepot.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 [ J prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration�Wizard by: 1�(orN t )—Date: M1 „ <br /> Accounting: Reviewed by: lirJ Date: g/Zf I/ Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> -------------------------------------------------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactiv d <br /> 2220-SM HW GEN<5 TONS/YR PRO541325 VICKI MCCARTNEY Active [ ] <br /> 1620-RETAIL MKT 26-300 SO FT(INCIDENTAL FOODS) PRO507976 JEFFREY WONG Inactive [ ] [ ] <br /> ��Jvv�� by reg M`xl, P_ [-kenrh . <br />