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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/16/2014 <br /> Submitted on: 5/20/2014 10:52:07AM CERS ID: 10146199 <br /> Submitted by: Nicole Long Email: Nicole.long@belshire.com <br /> Facility ID in CERS: FA0001705 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001336 <br /> Owner name Costco Wholesale Corporation Costco Wholesale Corporation 111 <br /> Mailing address 999 Lake Drive 999 Lake Drive 113 <br /> Issaquah, WA 98027 Issaquah, WA 98027 114,115, 116 <br /> Work phone 425-313-8100 (425) 313-8100 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001705 <br /> Facility name Costco Wholesale#38 Costco Wholesale#38 3 <br /> Site address 1616 E Hammer Ln 1616 E Hammer Ln 103 <br /> City Stockton Stockton 104 <br /> Zip code 95210 95210 <br /> 105 <br /> Facility phone 209-478-2040 (209)478-2040 102 <br /> Facility mailing address Costco Wholesale Attn: Licensing, PO Box c Costco Wholesale Attn: Licensing, PO Box 2 108a <br /> Seattle, WA 98124-3405 Seattle, WA 98124-3405 108b,108c,load <br /> BILLING INFORMATION <br /> Contact name Costco Wholesale Corporation, Environmen Costco Wholesale Corporation, Environmen 140 <br /> Address 999 Lake Drive 999 Lake Drive 143 <br /> Issaquah, WA 98027 Issaquah, WA 98027 144, 145 146 <br /> Contact phone 425-313-6110 (425) 313-6110 141 <br /> Contact email 142 <br /> Mail invoices to F. t k <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 [ j next calendarear <br /> y [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: (0• IV-14 <br /> --- ------ — — /File <br /> -- — - --- -- <br /> Accounting: Reviewedby: J. Date: /� Clerical: [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge ve fid B : Date: <br /> ------------------------ --- - <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1619-RETAIL MKT>1000 SQ FT(=/>2 DEPTS) PRO160939 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1633-FOOD VEHICLE/CART(LTD FOOD PREP) PRO163133 STEPHANIE RAMIREZ Inactive [ ] [ ] <br /> 1635-MOBILE FOOD PREPARATION UNIT(MFPU) PRO160999 STEPHANIE RAMIREZ Inactive [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO519873 LOWELLALLEN Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO517875 MICHELLE HENRY Active [ ] [ ] <br /> 2371 -UST FACILITY-1702 COMPLIANT PR0518624 GARRETT BACKUS Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0509785 HAZ MAT SJC DES Inactive [ ] [ ] <br /> J4740-WASTE TIRE SITE-EXEMPT PRO522399 HARPRIT MATTU Active [ ] [ ] <br />