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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/11/2014 <br /> Submitted on: 8/30/2013 1:43:19PM CERS ID: 10454887 <br /> Submitted by: Crystalyn Alford Email: calford@3ecompany.com Facility ID in CERS: FA0021446 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0017599 <br /> Owner name WALGREEN CO Walgreen Co. 111 <br /> Mailing address 440IRYAMMIT 200 Wilmot Road 113 <br /> DEERFIELD, IL 60015 Deerfield, IL 60015 114, 115, 116 <br /> Work phone (847) 914-2264 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021446 <br /> Facility name WALGREENS#12549 Walgreens#12549 3 <br /> Site address 2040 E MARIPOSA RD 2040 E Mariposa Rd 103 <br /> City STOCKTON Stockton 104 <br /> Zip code 95205 95205 105 <br /> Facility phone 9t7.4439+ (209)465-4167 102 <br /> Facility mailing address 3207 GREY HAWK CT STE 200 3E Company, Regulatory Dept/Walgreen, 32 108a <br /> CARLSBAD, CA 92010 Carlsbad, CA 92010 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name W"GREENS#12546 3E Company, Regulatory Dept/Walgreens 140 <br /> Address 3207 GREY HAWK CT STE 200 3207 Grey Hawk Court, Suite 200 143 <br /> CARLSBAD, CA 92010 Carlsbad, CA 92010 144, 145, 146 <br /> Contact phone Not Specified (760) 602-8700 141 <br /> Contact email regulatory@3ecompany.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG 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: Date: <br /> ------------------------------------------- <br /> Account[ng: Reviewed by: Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> m Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 16 ETAIL MKT>2000 SQ FT (PREPKGD/LTD PREP) PR0537331 LEYNA HUYNH Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO538446 MICHELLE HENRY Active [ ] [ ] <br /> 4557-MED STE LIMITED <br /> PR0537434 ROBERT MCCLELLON Active I 1 I 1 <br /> ra I- VAI <br />