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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/14/2015 <br /> Submitted on: 12/30/2014 1:56:13PM CERS ID: 10414483 <br /> Submitted by: Carissa Colli Email: carissa.souza@safeway.com Facility ID in CERS: FA0012734 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0009849 <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 ID FA0012734 <br /> Facility name Safeway Store 1769 Safeway Store 1769 3 <br /> Site address 2808 Country Club Blvd 2808 Country Club Blvd 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95204 95204 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,108c,108d <br /> BILLING INFORMATION <br /> Contact name Safeway, Inc Kathy Hjelm 140 <br /> Address 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 Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ j UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: WTD Date: l7 <br /> Accounting: Reviewed by: Dater -7 �� Clerical: �] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> --------- -- — ---- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1920-HMBP-Common Materials PR0537805 ROBERT LOPEZ Active [ I [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO538350 STACY RIVERA Active [ I [ ] <br />