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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 9/29/2016 <br /> Submitted on: 9/23/2016 4:22:58PM CERS ID: 10707490 <br /> Submitted by: Katherine Sorge Email: ksorge@kcgenviro.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: 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 OFFICE MAX#945 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,10ad <br /> BILLING INFORMATION <br /> Contact name OFFICE MAX#945 Deborah Roth 140 <br /> Address 3939 E HAMMER LN 6600 N. Military Trail 143 <br /> STOCKTON, CA 95212 Boca Raton, FL 33496 144, 145, 146 <br /> Contact phone 209-472-7002 (561)438-1409 141 <br /> Contact email Deborah.Roth@officedepot.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP Iq SQG HW [ ] LQG HW [ ] RCRA HW New PR#: F 54137.5 <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 1- <br /> Assigned to: V10142 cCa�kr <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: Date: /b� 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 Record ID Employee name Status Reactivated Inactivated <br /> 1620-RETAIL MKT 26-300 SQ FT(INCIDENTAL FOODS) PR0507976 JEFFREY WONG Inactive <br /> /I [ ] [ ] <br />