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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/14/2014 <br /> Submitted on: 9/29/2014 1:20:22PM CERS ID: 10521640 <br /> Submitted by: Chris Baker Email: Chris.Bakerc@stercycle.com Facility ID in CERS: FA0014817 <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 Dress For Less Inc. Ross Dress For Less Inc. 111 <br /> Mailing address 5130 Hacienda Dr 5130 Hacienda Dr 113 <br /> Dublin, CA 94568-7579 Dublin, CA 94568-7579 114, 115, 11E <br /> Work phone 925-965-4831 925-965-4831 112 <br /> FACILITY FILE INFORMATION <br /> Facility I D FA0014817 <br /> Facility name ROSS DRESS FOR LESS Ross Dress For Less #1389 3 <br /> Site address 2483 NAGLEE RD 2483 Naglee Rd 103 <br /> City TRACY Tracy 104 <br /> ZIP code 95304 95304 105 <br /> Facility phone 209-830-1182 209-830-1182 102 <br /> Facility mailing address 5130 HACIENDA DR 3RD FL 5130 Hacienda Dr 108a <br /> DUBLIN, CA 94568-7579 Dublin, CA 94568-7579 1a8b,108c,10E <br /> BILLING INFORMATION <br /> Contact name ROSS DRESS FOR LESS 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, 14E <br /> Contact phone 925-965-4526 925-965-4193 141 <br /> Contact emailJ sean.hewitt r@ros.com 142 <br /> Mail invoices to <br /> Program record ( ] HMBP ( ] SQG HW [ ] LQG HW [ ] RCRAHW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: '220 <br /> Assigned to: --T-,-..n <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by: _ .�Date: Clerical: [ ] File j ] Relabel file [ ] Create new file <br /> [ ] A ed [ ] Surchar ed' _ _ 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 1 LTD PREP) PR0521821 MELISSA NISSIM Active [ I [ ] <br />