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California Environmental Business Owner <br /> Reporting <br /> Operator <br /> acility/Site <br /> CERS ID <br /> S Pharmacy#9830 10184937 <br /> 632 Pacific Ave <br /> tockton,CA 95207 <br /> Submittal Status <br /> Submitted on 12/28/2017 by Renee Forero-Cook of CVS Health(Woonsocket,RI) <br /> identification <br /> Longs Drug Stores California,L.L.C. Beginning Date Ending Date <br /> Operator Phone Business Phone Business Fax 1/1/2018 1/1/2019 <br /> 401)765-1500 (209)951-6544 (209)478-8895 Dun&Bradstreet SIC Code Primary NAICs <br /> 001338912 5912 446110 <br /> Facility/Site Mailing Address rimary Emergency Contact <br /> VS Health,Attn:Dianne E.Durand,Licensing,One CVS Drive-MC 1160 /erisk 3E <br /> Woonsocket,RI 02895 ritle <br /> 4 Hour Emergency Call Center <br /> usiness Phone 24-Hour Phone Pager Number <br /> 888)464-2960 (888)464-2960 N/A <br /> Owner [econclary Emergency Contact <br /> Longs Drug Stores California,L.L.C. tthew Hunt <br /> 401)765-1500 ne CVS Drive re Manageroonsocket,RI 02895 ness Phone 24 Hour Phone Pager Number <br /> 209)951-6544 (925)628-0933 N/A <br /> Billing Contact nvironmental Contact <br /> VS Health;Attn:Dianne E.Durand, Licensing lerisk 3E,Regulatory Services/CVS,Attn:Stephen Horn <br /> 401)770-3315 Dianne.Durand@CVSHealth.com 760)602-8700 Regulatory@verisk3e.com <br /> One CVS Drive—MC 1160 3207 Grey Hawk Ct.,Ste.200 <br /> Woonsocket,RI 02895 arlsbad,CA 92010 <br /> Name of Signer Signer Title Document Preparer <br /> Renee Forero-Cook,Agent for Longs Drug Stores California,L.L.C. Regulatory Compliance Specialist,Verisk 3E Renee Forero-Cook,Agent for Longs Drug Stores <br /> California,L.L.C. <br /> Additional Information <br /> Locally-collected Fields <br /> Some or all of the following fields may be required by your local regulator(s). <br /> roperty Owner Assessor Parcel Number(APN) <br /> 08126020 <br /> ongs Drug Stores California,L.L.C. <br /> Number of Employees <br /> hone 26 <br /> 401)765-1500 Facility ID <br /> Mailing Address <br /> ne CVS Drive <br /> oonsocket,RI 02895 <br /> Printed on 12/28/2017 9:50 AM <br />