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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> E::— Changes to EnvisionConnect by CERS Integration Wizard <br /> Submitted on: 12/23/2014 5:11:48PM Date run: 1/13/2015 <br /> Submitted by: Lyazzat Segizbayeva Email: Isegizbayeva@3ecompany.com CERS ID: 10182333 <br /> Facility ID in CERS: FA0008046 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) <br /> Owner ID OW0001014 (current submittal) field <br /> Owner name Walgreen Co. <br /> Mailing address 200 Wilmot Road Walgreen Co. 111 <br /> Deerfield, IL 60015 200 Wilmot Road 113 <br /> Work phone 847-914-2264 Deerfield, IL 60015 114, 115, 116 <br /> (847) 914-2264 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0008046 <br /> Facility name WALGREENS#02770 <br /> Site address 7929 LOWER SACRAMENTO RD 7929 LO E R SACRAMENTO <br /> 3 <br /> City Stockton 7929 LOWER SACRAMENTO RD 103 <br /> ZIP code 95210 STOCKTON 104 <br /> Facility phone 209-474-0880 95210 105 <br /> (209)474-0880 102 <br /> Facility mailing address 3207 Grey Hawk Court, Suite 200 <br /> CARLSBAD, w 92010 3E Company, Reg.Dept./Walgreen Co., 3 108a <br /> CARLSBAD, CA 92010 1oeb,108q load <br /> BILLING INFORMATION <br /> Contact name 3E Company, Regulatory Dept/Walgreen Cc 3E Company, Regulatory Dept/Walgreen Cc 140 <br /> Address 3207 Grey Hawk Court, Suite 200 3207 Grey Hawk Court, Suite 200 143 <br /> CARLSBAD, CA 92010 CARLSBAD, CA 92010 144, 145, 146 <br /> Contact phone 760-602-8700 (760) 602-8700 141 <br /> Contact email regula ory@3ecompany.com regulatory@3ecompany.com 142 <br /> Mail invoices to Fpolity <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: VIA Date: 1 - 1151k <br /> 7 <br /> --- ----- ------------------- - <br /> Accounting: Reviewed by: — Lb Date: )�!'� I Clerical: File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> — -------------------------------- - --- - <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 SO FT (PREPKGD/LTD PREP) PR0508371 NICHOLAS WIESEMAN Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0538630 HAZA SAEED Active [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0535451 MICHELLE HENRY Active [ ] [ ] <br /> 4557-MED WASTE LIMITED HAULER PR0536048 ROBERT MCCLELLON Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0536010 not assigned Inactive [ ] [ ] <br />