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SAN JOAQUI tCOUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 9/5/2014 <br /> Submitted on: 9/4/2014 6:57:59AM CERS ID: 10181661 <br /> Submitted by: Frankie Motley Email: (motley@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 Orchard Supply Company, LLC OS Lodi LLC 111 <br /> Mailing address 1000 LOWES BLVD 102 Segolily Court 113 <br /> MOORESVILLE, NC 28117 Lincoln, CA 95648 114, 115,116 <br /> Work phone 925-275-1670 916-666-3955 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004567 <br /> Facility name ORCHARD SUPPLY HARDWARE#490 Tractor Supply Company, #1857 r/ 3 <br /> Site address 360 S CHEROKEE LN 160 S. <br /> CA__O�+ 103 <br /> City LODI Lodi 104 <br /> Zip code 95240 95240 105 <br /> Facility phone 209-368-2600 209-369-5528 102 <br /> Facility mailing address 1000 LOWES BLVD 5401 Virginia Way 108a <br /> MOORESVILLE, NC 28117 Brentwood, TN 37027 108b,1081,108d <br /> BILLING INFORMATION <br /> Contact name ORCHARD SUPPLY HARDWARE#490 Brian Spears 140 <br /> Address 1000 LOWES BLVD 5401 Virginia Way 143 <br /> MOORESVILLE, NC 28117 Brentwood, TN 37027 1", 145, 146 <br /> Contact phone Not Specified 615-440-4115 141 <br /> Contact email bspears@tractorsupply.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRAHW 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: W0 Date: �•� 't <br /> -- ---------- <br /> Accounting: Reviewed by: Date: z Clerical: File [ ] Relabel file—[—] Create new file <br /> -- <br /> ] Acct billed reHartJe+r� By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1615-RETAIL MKT 301-2000 So FT(PREPKGD/LTD PREP; PRO500069 STEPHANIE RAMIREZ Inactive [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO520360 JAMIE DE LA ROSA Inactive [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO535764 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 /> jet LA_� 2 C_4-e- S . <br />