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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS integration Wizard <br /> Date run: 7!1112014 <br /> Submitted on: 2/21/2014 10:19:03AM CERS ID: 10456801 <br /> Submitted by: Darryl Dinson Email: darryl.dinson@smartandfinal.com Facility ID in CERS: FA0006953 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0017262 <br /> Owner name CASH & CARRY STORES LLC SMART & FINAL LLC 111 <br /> Mailing address PO BOX 22008 P O. BOX 512377 ATTN: LOSS PREVENT 113 <br /> PORTLAND, OR 972692008 LOS ANGELES, ca 90051 114, 115. 116 <br /> Work phone 800-662-4242 323-869-7725 112 <br /> FACILITY FILE INFORMATION 1f <br /> Facility ID FA0006953 <br /> Facility name CASH & CARRY SMART FOODSERVICE asn Carry 517 j 3 <br /> Site address 6502 PACIFIC AVE 6502 Pacific Ave 103 <br /> City STOCKTON Stockton 104 <br /> Zip code 95207 95207 105 <br /> Facility phone 209-464-3759 209-477-4599 / 102 <br /> Facility mailing address PO BOX 22008 P.O. BOX 512377 K TN: LOSS PREVENT[, 108a <br /> PORTLAND, OR 972692008 LOS ANGELES, ca 90051 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name CASH & CARRY SMART FOODSERVICE Tomasa Scaccianoce 140 <br /> Address PO BOX 22008 P.O. BOX 512377 ATTN: LOSS PREVENTI- 143 <br /> PORTLAND, OR 972692008 LOS ANGELES, ca 90051 144, 145, 146 <br /> Contact phone 310-346-1805 323-869-7725 141 <br /> Contact email tomasa.scaccianoce@smartandfinal.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SOG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bili: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by: Date: f Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] A Illed [ ] Surch eve fied By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1618-RETAIL MKT>2000 SQ FT (PREPKGD 1 LTD PREP) PR0505703 MARIBEL FLOHRSCHUTZ Active 11 11 <br />