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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/21/2016 <br />Submitted on: 1/15/2016 12:03:05PM <br />Submitted by: Kirsten Scalese Email: kscalese@3ecompany.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 : 14 <br />OW0001014 <br />Walgreen Co. <br />200 Wilmot Rd. <br />Deerfield, IL 60015 <br />847-914-2264 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0018668 <br />Facility name <br />Walgreens #10631 <br />Site address <br />14780 HARLAN RD <br />City <br />LATHROP <br />ZIP code <br />95330-9719 <br />Facility phone <br />209-858-2801 <br />Facility mailing address 3207 GREY HAWK CT STE 200 <br />Carlsbad, CA 92010 <br />BILLING INFORMATION <br />Contact name Walgreens #10631 <br />Address 3207 GREY HAWK CT STE 200 <br />Carlsbad, CA 92010 <br />Contact phone Not Specified <br />Contact email regulatory@3ecompany.com <br />Mail invoices to Account <br />CERS ID: 10186943 <br />Facility ID in CERS: FA0018668 <br />Information after CIW processing CERS <br />(current submittal) field <br />Walgreen Co. 111 <br />200 Wilmot Road 113 <br />Deerfield, IL 60015 114, 115, 116 <br />(847) 914-2264 112 <br />Walgreens #10631 <br />3 <br />14780 Harlan Rd <br />103 <br />Lathrop <br />104 <br />95330-9719 <br />105 <br />(209)858-2801 <br />102 <br />3E Company, Regulatory Dept/Walgreen I 108a <br />Carlsbad, CA 92010 108b, 108c, 108d <br />3E Company, Regulatory Department/Wa 140 <br />3207 Grey Hawk Court, Suite 200 143 <br />Carlsbad, CA 92010 144, 145, 146 <br />(760) 602-8700 141 <br />regulatory@3ecompany.com 142 <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: 1/lf\ Date: <br />Accounting: Reviewed by: � Date: I 2i I Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated InactivWed <br />.1921 - HMBP-Regular-Primary Location PR0539321 PETER LOMBARDI Active [ ] k 7 <br />2220 - SM HW GEN <5 TONS/YR PR0535518 MICHELLE HENRY Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PRO535971 not assigned Inactive [ ] [ ] <br />