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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 2/28/2017 <br />Submitted on: 2/27/2017 10:09:18AM <br />Submitted by: Jessica Sutton Email: jessica.sutton@belshire, com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner : 12 <br />OW0000721 <br />7 -ELEVEN INC <br />P.O. BOX 711, ATTN: ENVIRONMENTAL D <br />DALLAS, TX 75221 <br />800-828-0711 <br />FACILITY FILE INFORMATION <br />CERS ID: 10165779 <br />Facility ID in CERS: FA0002064 <br />Information after CIW processing CERS <br />(current submittal) field <br />7 -ELEVEN INC. 111 <br />LICENSE RENEWAL DEPT.:3200 HACKBER 113 <br />IRVING, TX 75063 114, 115, 116 <br />972-828-7578 112 <br />Facility ID <br />FA0002064 <br />Employee name <br />Status Reactivated Inactivated <br />Facility name <br />7 -ELEVEN INC. STORE #14117 <br />7 -ELEVEN INC. STORE #14117 <br />3 <br />Site address <br />2725 COUNTRY CLUB BLVD <br />2725 COUNTRY CLUB BLVD <br />103 <br />City <br />Stockton <br />Stockton <br />104 <br />ZIP code <br />95204 <br />95204 <br />105 <br />Facility phone <br />209-463-1259 <br />209-463-1259 <br />102 <br />Facility mailing address <br />1722 ROUTH STREET <br />LICENSE RENEWAL DEPT.:3200 HACKBER <br />108a <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />DALLAS, TX 75201 <br />IRVING, TX 75063 108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name <br />7 -ELEVEN INC. ATTN: RICHARD MILLS <br />7 -ELEVEN INC. ATTN: BRENT SMERCZYNS <br />140 <br />Address <br />1722 ROUTH STREET <br />LICENSE RENEWAL DEPT.:3200 HACKBER <br />143 <br />DALLAS, TX 75201 <br />DALLAS, TX 75201 144, 145, 146 <br />Contact phone <br />972-828-6586 <br />972-828-7578 <br />141 <br />Contact email <br />RICHARD. MI LLS@7-11.COM <br />BRENT.SMERCZYNSKI@7-11.COM <br />142 <br />Mail invoices to <br />Account <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: <br />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: <br />Accounting: Reviewed by: Date: 3/ I 0 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1919 - HMBP-0O2 Only Food Facility 1 chem units <br />PR0519761 <br />MARIBEL FLOHRSCHUTZ <br />Active [ ] [ ] <br />2220 - SM HW GEN <5 TONS/YR <br />PRO518490 <br />STACY RIVERA <br />Inactive [ ] [ ] <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0511889 <br />HAZ MAT SJC OES <br />Inactive [ ] [ ] <br />2301 - UST STATE SURCHARGE FEE <br />PRO508311 <br />MICHAEL KITH <br />Inactive [ ] [ ] <br />2361 - UST FACILITY <br />PR0231073 <br />STACY RIVERA <br />Inactive [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PRO507291 <br />MICHAEL KITH <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0533925 <br />not assigned <br />Inactive [ ] [ ] <br />