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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 5/12/2015 <br /> Submitted on: 4/2/2015 2:39:27PM CERS ID: 10453774 <br /> Submitted by: Brian Spears Email: bspears@tractorsupply.com Facility ID in CERS: FA0022513 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0020036 <br /> Owner name LRF Properties, LLC Tractor Supply Company 111 <br /> Mailing address 1120 Maybrown Avenue 5401 Virginia Way 113 <br /> Menlo Park, CA 94025 Brentwood, TN 37027 114, 115, 116 <br /> Work phone 650-326-6179 615-440-4660 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022513 <br /> Facility name Tractor Supply Store#1303 Tractor Supply Store#1303 3 <br /> Site address 860 N Jack Tone Rd 860 N Jack Tone Rd 103 <br /> City Ripon Ripon 104 <br /> ZIP code 95366 95366 105 <br /> Facility phone 615440-4600 (615)440-4600 102 <br /> Facility mailing address 5401 VIRGINIA WAY 5401 Virginia Way 108a <br /> BRENTWOOD, TN 37027-7536 Brentwood, TN 37027 108b, 108c,toad <br /> BILLING INFORMATION <br /> Contact name Tractor Supply Store#1303 Brian Spears 140 <br /> Address 5401 VIRGINIAWAY 5401 Virginia Way 143 <br /> BRENTWOOD, TN 37027-7536 Brentwood, TN 37027 144, 145, 146 <br /> Contact phone Not Specified (615)440-4115 141 <br /> Contact email bspears@tractorsupply.com bspears@tractorsupply.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PRM <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] 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: 212 Date: /• /J <br /> ------------------------------------------------ -- <br /> Accounting: Reviewed by: U5 Date: 51131 S 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 /> 1920-HMBP-Common Materials PRO539380 MICHAEL PARISSI Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0539379 CINDY VO Active [ ] [ ] <br />