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SAN JOAQUI*COUNTY ENVIRONMENTAL HEALTHIEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/13/2016 <br /> Submitted on: 1/7/2016 11:31:37AM CERS ID: 10413040 <br /> Submitted by: Ken Dobias Email: ken.dobias@questrmg.com Facility ID in CERS: FA0002222 <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: 11 <br /> Owner ID OW0000531 <br /> Owner name DOLGEN CALIFORNIA, LLC DOLGEN CALIFORNIA, LLC 111 <br /> Mailing address 100 MISSION RIDGE 100 MISSION RIDGE 113 <br /> GOODLETTSVILLE, TN 37072 GOODLETTSVILLE, TN 37072 114, 115, 116 <br /> Work phone 615-855-4638 6158554638 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002222 <br /> Facility name Dollar General#13593 Dollar General#13593 3 <br /> Site address 4232 E Main St 4232 E Main St 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95215 95215 105 <br /> Facility phone 209-800-8822 (209) 800-8822 102 <br /> Facility mailing address 100 MISSION RIDGE 100 MISSION RIDGE 108a <br /> GOODLETTSVILLE, TN 37072 GOODLETTSVILLE, TN 37072 108b, 108C,108d <br /> BILLING INFORMATION <br /> Contact name ERIC VOYLES ERIC VOYLES 140 <br /> Address 100 MISSION RIDGE 100 MISSION RIDGE 143 <br /> GOODLETTSVILLE, TN 37072 GOODLETTSVILLE, TN 37072 144, 145, 146 <br /> Contact phone 615-855-4024 615-855-4024 141 <br /> Contact email WMANAGEM@DOLLARGENERAL.COM EnvCompliance@dollargeneral.com 142 <br /> Mail invoices to Account <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 calendarear <br /> y [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: I " Date: I \5 /I <br /> Accounting: Reviewed by:�— Date: ZI Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge vers ed 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) PRO161585 LEYNA HUYNH Active [ ] [ ] <br /> 1-2zzo-SM HW GEN<5 TONSNR PR0537835 STACY RIVERA Active [ ] [ ] <br /> 1698-SPECIAL EVENT PRO537166 LEYNAHUYNH Inactive [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO539167 NICHOLAS LOEHRER Inactive pQ [ ] <br /> 3116-STORMWATER INSPECTION-FOOD PRO522926 VIDAL PEDRAZA Inactive [ ] [ ] <br /> Per utna;l feAc PF 191l 4,a jk a,4 <br />