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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 612/2017 <br /> Submitted on: 611!2017 3:04:41 PM CERS ID: 10672645 <br /> Submitted by: Laura Payne Email: laura.payne@cbi.com Facility ID in CERS: FA0016654 <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: 9 <br /> Owner ID OW0013498 <br /> Owner name Petco Animal Supplies LLC Petco Animal Supplies LLC 111 <br /> Mailing address 654 Richland Hills 654 Richland Hills 113 <br /> San Antonio, TX 78245 San Antonio, TX 78245 114, 115, 116 <br /> Work phone 210-201-9217 210-201-9217 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016654 <br /> Facility name Petco#1319 Petco#1319 3 <br /> Site address 5406 Pacific Ave 5406 Pacific Ave 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-478-7726 209-478-7726 102 <br /> Facility mailing address 654 Richland Hills 654 Richland Hills 108a <br /> San Antonio, TX 78245 San Antonio, TX 78245 108e. 108c,108d <br /> BILLING INFORMATION <br /> Contact name PETCO#1319 Petco Animal Supplies, Inc. SSE, Attn: Amy 140 <br /> Address 654 Richland Hills 654 Richland Hills 143 <br /> San Antonio, TX 78245 San Antonio, TX 78245 144, 145, 146 <br /> Contact phone 210-201-9217 210-201-9217 141 <br /> Contact email safety@petco.com safety@petco.corrm 142 <br /> Mail invoices to Account <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 [rj next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: v� Date: <br /> Accounting: Reviewed by: ��- Date: rj' Clerical: [ ] File [ ] Relabel file [ ] 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 /> 2220-SM HW GEN<5 TONS/YR PRO5 11075 VICKI MCCARTNEY Active [ ] [ ] <br /> 4557-MED WASTE LIMITED HAULER PR0524803 ROBERT MCCLELLON Inactive [ ] [ ] <br />