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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/28/2015 <br /> Submitted on: 4117/2015 9:41:37AM CERS ID: 10413025 <br /> Submitted by: Nina Burse Email ashley.campbell@pscnow.com Facility ID in CERS: FA0001305 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000531 <br /> Owner name DOLLEN CALIFORNIA, LLC DOLLEN 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 615-855-4024 6158554638 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001305 <br /> Facility name Dollar General #13568 Dollar General#13568 3 <br /> Site address 560 N Main St 560 N Main St 103 <br /> City Manteca Manteca 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 209-823-3164 (209) 823-3164 102 <br /> Facility mailing address 100 MISSION RIDGE 100 MISSION RIDGE 1080 <br /> GOODLETTSVILLE, TN 37072 GOODLETTSVILLE, TN 37072 108b, 108c 1060 <br /> BILLING INFORMATION <br /> Contact name DOLLAR GENERAL ERIC VOYLES 140 <br /> Address 100 MISSION RIDGE a' 100 MISSION RIDGE 143 <br /> GOODLETTSVILLE, TN 37072 GOODLETTSVILLE, TN 37072 144, 145, 146 <br /> Contact phone 615-855-4638 615-855-4024 141 <br /> Contact email WMANAGEM@DOLLARGENERAL.COM WMANAGEM@DOLLARGENERAL.COM 142 <br /> Mail invoices to Facility- ✓ <br /> Program record [ ] HMBP ( ] SOG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaiARP [ ] LIST 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: Date: 1� <br /> Accounting: Reviewed by: Date: S4 Y Clerical: [ j File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified 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 X2000 SO FT (PREPKGD 1 LTD PREP) PR0163175 KADEA'NNE LINHARES Active [ ] [ ] <br /> 1698-SPECIAL EVENT PR0537163 KADEANNE LINHARES Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0539169 MICHAEL PARISSI Active <br /> 2220-SM HW GEN<5 TONSIYR PRO537830 STACY RIVERA Active [ ] [ ] <br />