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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/2/2014 <br /> Submitted on: 1/24/2014 6:27:57AM CERS ID: 10187409 <br /> Submitted by: Stephanie Fleischer Email: sfleischer@3ecompany.com Facility ID in CERS: FA0019897 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0016236 <br /> Owner name Longs Drug Stores California, L.L.C. Garfield Beach CVS, L.L.C. 111 <br /> Mailing address 1 CVS Drive 1 CVS Drive 113 <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 114, 115, 116 <br /> Work phone 401-770-3315 (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 209-566-5875 (209) 825-4685 <br /> 102 <br /> Facility mailing address ONE CVS DR MAIL DROP 23062A CVS rk, Attn: Dianne E. Durand, 1 C 108a <br /> WOONSOCKET, RI 02895 oonsocket, RI 02895 108b,108c,1086 <br /> BILLING INFORMATION <br /> Contact name CVS/PHARMACY#5403 CVS Caremark, Attn: Dianne E. Durand 140 <br /> Address ONE CVS DR MAIL DROP 23062A 1 CVS Drive-23062A 143 <br /> WOONSOCKET, RI 02895 Woonsocket, RI 02895 144, 145, 146 <br /> Contact phone 401-770-2272 (401) 770-3315 141 <br /> Contact email Dianne.Durand@CVSCaremark.com 142 <br /> Mail invoices to FaciFifv e- <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: -I.'L Date: <br /> Accounting: Reviewed by: _a Date: 19rX //7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] A filled [ ] Surc ge verfiedI 7 ____ By:__ Date_ <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1618-RETAIL MKT>2000 SQ FT (PREPKGD/LTD PREP) PRO530691 LISA MEDINA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0531041 MICHELLE HENRY Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PRO531914 not assigned Inactive [ ] [ ] <br />