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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/5/2015 <br /> Submitted on: 12/30/2014 1:12:33PM CERS ID: 10156529 <br /> Submitted by: Carissa Colli Email: carissa.souza@safeway.com Facility ID in CERS: FA0012254 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0009310 <br /> Owner name Safeway, Inc Safeway, Inc 111 <br /> Mailing address 5918 Stoneridge Mall Rd 5918 Stoneridge Mall Rd. 113 <br /> Pleasanton, CA 94588 Pleasanton, CA 94588 114, 115, 11E <br /> Work phone 925-467-3000 925-467-3000 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012254 <br /> Facility name Safeway 1648 Safeway 1648 3 <br /> Site address 2449 W Kettleman Ln 2449 W Kettleman Ln 103 <br /> City Lodi 104 <br /> ZIP code 95242 95242 105 <br /> Facility phone 925-467-3000 925-467-3000 102 <br /> Facility mailing address PO BOX 9070 Lodi PO Box 29096, MS 6516 108a <br /> Pleasanton, Ca 94588 Phoenix,AZ 85038 108b,108c,10e <br /> BILLING INFORMATION <br /> Contact name Safeway 1648 Kathy Hjelm 140 <br /> Address PO BOX 9070 PO Box 29096, MS 6516 143 <br /> Pleasanton, Ca 94588 Phoenix,AZ 85038 144, 145, 14E <br /> Contact phone Not Specified 623-869-3577 141 <br /> Contact email rob.singh@safeway.com kathy.hjelm@safeway.com 142 <br /> Mail invoices to <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 calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: ill`f Date: IIS/lS <br /> I <br /> Accounting: Reviewed by: S Date: 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 /> 1921 -HMBP-Regular-Primary Location PRO538960 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0538959 MICHELLE HENRY Active [ ] [ ] <br />