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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1012612015.. <br /> Submitted on: 10/2112015 1:59:03PM CERS ID: 10647787 <br /> Submitted by: Ken Dobias Email: ken.dobias@questrmg.com Facility ID in CERS: ir:c:o rec: <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 3 <br /> Owner 1D OW0014982 <br /> Owner name PETSMART INC PetSmart, Inc. 111 <br /> Mailing address PO BOX 43009 19601 N. 27th Avenue 113 <br /> PHOENIX, AZ 850803007 Phoenix, AZ 85027 114, 115, 116 <br /> Work phone 623-580-6100 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018246 <br /> Facility name PETSMART#1164 PetSmart#1164 3 <br /> Site address 2477 NAGLEE RD 2477 Naglee Rd 103 <br /> City TRACY Tracy 104 <br /> ZIP code 95304 95304 105 <br /> Facility phone 209-836-6080 209-836-6080 102 <br /> Facility mailing address PO BOX 43009 Contracted Services, 19601 N 27th Ave 108a <br /> PHOENIX, AZ 85080 Phoenix, AZ 85027 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name PETSMART#1164 Accounts Payable 140 <br /> Address PO BOX 43009 19601 N. 27th Avenue )? ivy 'f3ao�j 143 <br /> PHOENIX, AZ 85080 Phoenix, AZ 86822- gs Oec> 144. 145, 146 <br /> Contact phone 623-388-8300 623-587-2662 141 <br /> Contact email invoices-petsmart@petsmart.com 142 <br /> Mail invoices to Faci ' P( <br /> Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: U'.; <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP C ] UST New PE: �-�- <br /> Assigned to: -CY2,ANI <br /> Please bill: ] prorate this_ tcalendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by: ti!5 Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ 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 SQ FT(INCIDENTAL FOODS) PR0526934 MELISSA NISSIM Inactive <br /> -(�V- '�?DIr0 L,T <br />