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E— SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/30/201 <br /> Submitted on: 12/29/2016 10:40:43AM CERS ID: 10187409 <br /> Submitted by: Tristan Guison Email: tguison@3ecompany.com Facility ID in CERS: FA0019897 <br /> Information prior to CIW proces Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (currentmittal) field <br /> Number of Facilities for this Owner.. 11 <br /> Owner ID OW0016236 OW—)00.2,a4 <br /> Owner name Longs Drug Stores California, L. Garfield Beach CVS, L.L.C. 111 <br /> Mailing address One CVS Drive One CVS Drive 113 <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 114, 115, 116 <br /> Work phone 401-765-1500 (401) 765-1500 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019897 <br /> Facility name CVS Pharmacy#5403 CVS Pharmacy#5403 3 <br /> Site address 1175 W Lathrop Rd 1175 W Lathrop Rd 103 <br /> City Manteca Manteca 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 209-825-4685 (209) 825-4685 102 <br /> Facility mailing address CVS Health, Attn: Licensing, One CVS Dr. - One CVS Dr. -MC 1160 108a <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name CVS Health, Attn: Dianne Durand, Licensing CVS Health, Attn: Dianne E. Durand, Licens 140 <br /> Address One CVS Drive–MC 1160 One CVS Drive–MC 1160 143 <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 144, 145, 146 <br /> Contact phone 401-770-3315 (401) 770-3315 141 <br /> Contact email Dianne.Durand@CVSCaremark.com Dianne.Durand@CVSHealth.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ j RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP <br /> [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate <br /> ,this <br /> ,c1alendar year [ j next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: I a 30 1 <br /> - - - -- --- - - - - -- --- - <br /> Accounting: Reviewed by: 116 Date: 11411 7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1618-RETAIL MKT>2000 So FT (PREPKGD/LTD PREP) PR0530691 KADEANNE LINHARES Active [ ] [ ] <br /> 2247-RCRA GEN 5<25 TONS PR0531041 ELENA MANZO Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location 10 chem units PRO539324 NICHOLAS LOEHRER Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531914 not assigned Inactive [ ] [ ] <br />