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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 9127/2016 <br /> Submitted on: 9/2212016 8:55:25AM CERS ID: 10655518 <br /> Submitted by: Jeremy Hojnicki Email: jhojnicki@ulta.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 /> Number of Facilities for this Owner : 1 <br /> Owner ID OW0021540 <br /> Owner name Tracey Anzar Ulta Beauty 111 <br /> Mailing address 1000 Remington Blvd 1000 Remington Blvd, Suite 120 113 <br /> Bolingbrook, IL 60446 Bolingbrook, IL 60440 114, 115, 116 <br /> Work phone 630-378-7398 630-410-4800 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0023322 <br /> Facility name ULTA BEAUTY#314 ULTA BEAUTY#314 3 <br /> Site address 5410 Pacific Ave 5410 Pacific Ave 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 630-378-7398 630-410-4800 102 <br /> Facility mailing address 1000 Remington Blvd Suite 200 5410 Pacific Avenue 108a <br /> Bolingbrook, IL 60446 Stockton, CA 95207 10eb 10ec 108d <br /> BILLING INFORMATION <br /> Contact name Nedra Allen Nedra Allen 140 <br /> Address 1000 Remington Blvd Ste 120 1000 Remington Blvd, Ste 120 143 <br /> Bolingbrook, IL 60446 Bolingbrook, IL 60440 144, 145, 146 <br /> Contact phone 630-410-4814 630-410-4814 141 <br /> Contact email nallen@ulta.com nallen@u'Ita.com 142 <br /> Mail jnvojces 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 callendar year [ ] next calendar year [ ] exempt from billing <br /> sc <br /> Processed through CERS Integration Wizard by: �]. Date: <br /> Accounting: Reviewed by: Dater Clerical ( ] 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 /> 1921 -HMBP-Regular-Primary Location PR0540795 HAZA SAEED Active [ ] <br /> 2220-SM HVV GEN <5 TONS/YR PRO540794 VICKI MCCARTNEY Active [ ] [ ] <br /> PE 10221 <br /> '�v�owckd 4�- be l W <br /> q(z�(Le W9 5, <br /> 'rwtCa� (v �� �P�y 1•fa��e��.- ���' <br />