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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 111412015 <br /> Submitted on: 1213012014 2:05:47PM CERS ID: 10416754 <br /> Submitted by: Carissa Colli Email: carissa.souza@safeway.com Facility ID in CERS: FA0002417 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner 1D OW0009310 <br /> Owner name Safeway, Inc Safeway, Inc 111 <br /> Mailing address 5918 Stoneridge Mall Rd 5918 Stoneridge Mall Rd 113 <br /> Pleasanton, CA 94588 Pleasanton, CA 94588 114, 115, 116 <br /> Work phone 925-467-3000 925-467-3000 112 <br /> FACILITY FILE INFORMATION <br /> Facility I D FA0002417 <br /> Facility name Safeway Store 2707 Safeway Store 2707 3 <br /> Site address 6445 Pacific Ave 6445 Pacific Ave 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 925-467-3000 925-467-3000 102 <br /> Facility mailing address 5918 Stoneridge Mall Rd PO Box 29096, MS 6516 108a <br /> Pleasanton, CA 94588 Phoenix, AZ 85038 108b, icac,108d <br /> BILLING INFORMATION <br /> Contact name Rob Singh Kathy Hjelm 140 <br /> Address PO Box 9070]6000 Stoneridge Mall Rd PO Box 29096, MS 6516 143 <br /> Pleasanton, CA 94588 Phoenix, AZ 85038 144, 145, 146 <br /> Contact phone 925-469-7164 623-869-3577 141 <br /> Contact email rob.singh@safeway.com kathy.hjelm@safeway.com 142 <br /> Mail invoices to F-aciiif"y <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: I ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> , <br /> Processed through CERS Integration Wizard by: AJ Date: [ i <br /> Accounting: Reviewed by: ' Lr� Date: i f 7 5� 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-Reguiar-Primary Location PR0539350 HAZA SAEED Active [ ] [ 1 <br /> 2220-SM HW GEN <5 TONS/YR PRO516649 FATINAH ZAREEF Active [ ] [ ] <br /> 2233-HAZARDOUS WASTE CESQT FACILITY PRO506917 MICHAEL KITH Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM EAC STATE SURCHARGE FEE PRO506919 MICHAEL KITH Inactive [ ] [ ] <br />