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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 4/7/2017 <br /> Submitted on: 2/27/2017 5:50:54PM CERS ID: 10505809 <br /> Submitted by: Ashley Campbell Email: Ashley.Cam pbell@stericycle.com Facility ID in CERS: FA0002178 <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: 8 <br /> Owner ID OW0001693 <br /> Owner name Ross Dress For Less Inc. Ross Dress For Less Inc. 111 <br /> Mailing address 5130 Hacienda Dr 5130 Hacienda Dr 113 <br /> Dublin, CA 94568-7579 Dublin, CA 94568-7579 114, 115, 116 <br /> Work phone 925-965-4831 925-965-4831 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002178 <br /> Facility name Ross Dress For Less#0035 Ross Dress For Less#0035 3 <br /> Site address 5756 PACIFIC AVE STE 60 5756 Pacific Ave Ste 60 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-957-6202 209-957-6202 102 <br /> Facility mailing address 5130 Hacienda Dr 5130 Hacienda Dr 108a <br /> Dublin, CA 94568-7579 Dublin, CA 94568-7579 108b, 108c, 108d <br /> BILLING INFORMATION <br /> Contact name KATHY HATCH/LICENSING DEPT KATHY HATCH/LICENSING DEPT 140 <br /> Address 5130 Hacienda Dr 5130 Hacienda Dr 143 <br /> Dublin, CA 94568-7579 Dublin, CA 94568-7579 144, 145, 146 <br /> Contact phone 925-965-4526 925-965-4526 141 <br /> Contact email LICENSING@ROS.COM LICENSING@ROS.COM 142 <br /> Mail invoices to Account <br /> Program record HMBP [ ] SQG HW [ ] LQG HW [ ] RCRAHW New PR#: PAOSLA170tl <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: Mt.0 <br /> Assigned to: Miy 1e, G^,ok <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: 0or-n h Date: LA-_7'I-7 <br /> `� // 1 7 Create new file Clerical: [ ] File Relabel file <br /> Accounting: Reviewed by: Date: 1 [ ] [ ] <br /> [ Acct billed [ urcharge verified By: Date: <br /> - - - - - -- - — — — — — <br /> - - - - - - -- - --- <br /> ACTIVE ROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1615-RETAIL MKT 301-2000 SOFT(PREPKGD/LTD PREP; PRO163334 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0539592 VICKI MCCARTNEY Active [ ] [ ] <br />