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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 4/25/2017 <br /> Submitted on: 2/27/2017 6:50:57PM CERS ID: 10508965 <br /> Submitted by: Ashley Campbell Email: Ashley.Campbell@stericycle.com Facility ID in CERS: FA0012563 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> (current EC database) (current submittal) field <br /> OWNER INFORMATION Number of Facilities for this Owner: 8 <br /> Owner ID OW0001693 <br /> Owner name Ross Dress For Less Inc. Ross Dress For Less Inc. 113 <br /> Mailing address 5130 Hacienda Dr 5130 Hacienda Or <br /> Dublin, CA 94568-7579 Dublin, CA 94568-7579 11a, 115,11s <br /> Work phone 925-965-4831 925-965-4831 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012563 <br /> Facility name Ross Dress For Less#0477 Ross Dress For Less#0477 3 <br /> Site address 340 W Kettleman Ln 340 W Kettleman Ln 103 <br /> City Lodi Lodi 104 <br /> ZIP code 95240 95240 105 <br /> Facility phone 209-369-1386 209-369-1386 102 <br /> Facility mailing address 5130 Hacienda Dr 5130 Hacienda Dr 108a <br /> Dublin, CA 94568-7579 Dublin, CA 94568-7579 108b. 108c,1084 <br /> BILLING INFORMATION <br /> Contact name ROSS DRESS FOR LESS INC#0477 KATHY HATCH/LICENSING DEPT 140 <br /> Address 5130 Hacienda Dr 5130 Hacienda Or 143 <br /> Dublin, CA 94568-7579 Dublin, CA 94568-7579 144, 145, 146 <br /> Contact phone 925-965-4526 925-965-4526 141 <br /> Contact email LICENSING@ROS.COM LICENSING@ROS.COM 142 <br /> Mail invoices to Account <br /> Program record [ HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: PPD 5-'-1 4zi, <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: l�Z <br /> Assigned to: <br /> Please bill: [ J full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: 100r" Date: '2'5.-(7 <br /> ---------------------------------- ---- <br /> Accounting: Reviewed by: Lb Date: 5/ZI11 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> ---- Acct billed [tj Surcharge verified By: — Date_ <br /> —-- ——————— ——————— ———— - - <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1615-RETAIL MKT 301-2000 SQ FT(PREPKGD/LTD PREP; PRO516336 STEPHANIE RAMIREZ Active I I [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0539585 ONE VACANT? Active I I I ] <br /> 15-7 <br />