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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/30/2016 <br /> Submitted on: 12/29/2016 10:44:52AM CERS ID: 10180973 <br /> Submitted by: Tristan Guison Email: tguison@3ecompany.com Facility ID in CERS: FA0002588 <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 OW0016236 <br /> Owner name Garfield Beach CVS, L.L.C. Longs Drug Stores California, L.L.C. 111 <br /> Mailing address One CVS Drive One CVS Drive 113 <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 114, 115, 116 <br /> Work phone 401-765-1500 (401) 765-1500 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002003 <br /> Facility name CVS Pharmacy#9147 CVS Pharmacy#9147 3 <br /> Site address 2605 W March Ln 2605 W March Ln 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-952-3494 (209) 952-3494 102 <br /> Facility mailing address 1 CVS Dr, MC 1160 CVS Health, Attn: Dianne E. Durand, Licens 108a <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 108b. 108C.load <br /> BILLING INFORMATION <br /> Contact name CVS Health, ATTN: DIANNE E DURAND, Li CVS Health, Attn: Dianne E. Durand, Licens 140 <br /> Address 1 CVS Dr, MC 1160 One CVS Drive—MC 1160 143 <br /> Woonsocket, RI 02895 Woonsocket, RI 02895 144, 145, 146 <br /> Contact phone Not Specified (401) 770-3315 141 <br /> Contact email Dianne.Durand@CVSHealth.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG 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: ,601L M Date: 12,42701((P <br /> Accounting: Reviewed b Date: t Clerical: [ ] File Relabel file <br /> Y / 117 [ ] [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1618-RETAIL MKT>2000 SO FT (PREPKGD/LTD PREP) PRO160134 VIDAL PEDRAZA Active [ ] [ ] <br /> 2247-RCRA GEN 5<25 TONS PR0537749 VICKI MCCARTNEY Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location 1 chem units PRO520723 HAZA SAEED Inactive <br /> 2200-HAZARDOUS WASTE GENERATOR PROGRAM PR0538636 MICHELLE HENRY Inactive [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513465 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO511177 HAZ MAT SJC OES Inactive [ ] ( ] <br />