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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 10/23/201 <br /> Submitted on: 9/5/2014 10:50:07AM CERS ID: 10181661 <br /> Submitted by: Frankie Motley Email: fmotley@tractorsupply.com Facility ID in CERS: FA0004567 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0018049 <br /> Owner name OS Lodi LLC OS Lodi LLC 111 <br /> Mailing address 102 Segolily Court 102 Segolily Court 113 <br /> Lincoln, CA 95648 Lincoln, CA 95648 114, 115,116 <br /> Work phone 209-369-5528 916-666-3955 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004567 <br /> Facility name Tractor Supply Company,#1857 Tractor Supply Company, #1857 3 <br /> Site address 360 S CHEROKEE LN 360 S Cherokee Ln 103 <br /> City LODI Lodi 104 <br /> Zip code 95240 95240 105 <br /> Facility phone 209-369-5528 209-369-5528 102 <br /> Facility mailing address 5401 Virginia Way 5401 Virginia Way 108a <br /> Brentwood, TN 37027 Brentwood, TN 37027 10eb,toed,coed <br /> BILLING INFORMATION <br /> Contact name Tractor Supply Company#1857 Brian Spears 140 <br /> Address 5401 Virginia Way 5401 Virginia Way 143 <br /> Brentwood, TN 37027 Brentwood, TN 37027 144, 145,146 <br /> Contact phone 615-440-4115 615-440-4115 141 <br /> Contact email bspears@tractorsupply.com bspears@tractorsupply.com 142 <br /> Mail invoices to Account <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: [ ] full calendar year [ ] prorate this calendar year ( ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: to.'k3- %I <br /> ---------------- ----- -- --- <br /> �7 - <br /> Accounting: Reviewed by: X Date: Clerical: t ] File [ ] Relabel file [ ] Create new file <br /> ---- [ ] - ct --- [ ] — -- e-- By: Date: <br /> - -----------y- <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 PR0520360 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0535764 MICHELLE HENRY Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510059 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533774 not assigned Inactive [ ] [ ] <br />