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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/6/2014 <br /> Submitted on: 9/29/2014 1:08:36PM <br /> Submitted by: Chris Baker Email: Chris.Baker@stericycle.com CE1 <br /> Facility ID inn C CERR S: FA00012 65 <br /> 563 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001693 <br /> Owner name ROSS STORES INC Ross Dress For Less Inc. 111 <br /> Mailing address 5130 HACIENDA DR 3RD FLOOR 5130 Hacienda Dr 113 <br /> DUBLIN, CA 94568-7579 Dublin, CA 94568-7579 11a, 11 s, 11E <br /> Work phone Not Specified 925-965-4831 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012563 <br /> Facility name ROSS STORES INC#477 Ross Dress For Less#0477 3 <br /> Site address 340 W KETTLEMAN LN 340 W Kettleman Ln 103 <br /> City LODI 104 Lodi <br /> Zip code 95240 Lodi <br /> i105 <br /> Facility phone Not Specified 95240 209-369-1386 102 <br /> Facility mailing address 5130 HACIENDA DR 3RD FL 5130 Hacienda Dr 108a <br /> DUBLIN, CA 94568-7579 Dublin, CA 94568-7579 108b,1080.10E <br /> BILLING INFORMATION <br /> Contact name ROSS STORES INC#477 Sean Hewitt 140 <br /> Address 5130 HACIENDA DR 3RD FL 5130 Hacienda Dr 143 <br /> DUBLIN, CA 94568-7579 Dublin, CA 94568-7579 144, 145, 14( <br /> Contact phone Not Specified 925-965-4113 141 <br /> Contact email sean.hewitt@ros.com 142 <br /> Mail invoices to Facility fI � <br /> Program record [ ] HMBP [X] SQGHW [ ] LQGHW [ ] RCRAHW New PR#: G�39�-gS <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 72z0 <br /> Assigned to: WAosr' <br /> Please bill: [ ] full calendar year [ j prorate this calendar year [ ] next calendar year [ j exempt from billing <br /> Processed through CERS Integration Wizard by: .I Date: i /6 ;-i <br /> Accounting: Reviewed by:i— Date: J Clerical: File [ ] Relabel file [K] Create new file <br /> [ ] A illed [ ] Surc 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 So FT(INCIDENTAL FOODS) PR0516336 NICHOLAS WIESEMAN Active [ ] [ ) <br /> Glee P v <br />