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SAN JOAQU&.ZOUNTY ENVIRONMENTAL HEALTF. EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 4/10/2015 <br /> Submitted on: 2/11/2015 6:16:15PM CERS ID: 10617937 <br /> Submitted by. Melonee Cruse Email: mcruse@familydollar.com Facility ID in CERS: incorrect <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0020085 <br /> Owner name Family Dollare Stores Family Dollar Stores, Inc. 111 <br /> Mailing address P.O. Box 1017 P.O. Box 1017 113 <br /> Charlotte, NC 28201 Charlotte, NC 28201 114, 115, 116 <br /> Work phone Not Specified 866-377-6420 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022690 <br /> Facility name FAMILY DOLLAR STORE#11092 Family Dollar Store#11092 3 <br /> Site address 2006 E MARIPOSA RD 2006 E Mariposa Rd 103 <br /> City STOCKTON Stockton 104 <br /> ZIP code 95205 95205 105 <br /> Facility phone Not Specified 866-377-6420 102 <br /> Facility mailing address PO BOX 1017 P.O. Box 1017 108a <br /> CHARLOTTE, NC 28201 Charlotte, NC 28201 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name FAMILY DOLLAR STORE#11092 Kelvin Davis 140 <br /> Address PO BOX 1017 P.O. Box 1017 143 <br /> CHARLOTTE, NC 28201 Charlotte, NC 28201 144, 145, 146 <br /> Contact phone Not Specified 704-708-1649 141 <br /> Contact email c kdavis@familydollar.com 142 <br /> Mail invoices to F� A- �pD*I 5��1 <br /> Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: Qrb5�9 r1 Y� <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: 2220 <br /> Assigned to: VV <br /> Please bill: full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by:V—Date: LA•to•t{) <br /> ----------------------------------- --------------- <br /> Accounting: Reviewed by: Lf�> Date: 15 Clerical: [ ] File [ ] Relabel file )d Create new file <br /> ___ Acct billed_ ] Surcharge verified <br /> -------------By: <br /> ----- 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/LTD PREP) PR0539650 LEYNA HUYNH Active I I I I <br />