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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/2/2015 <br />Submitted on: 3/5/2015 8:42:29AM <br />Submitted by: Tim Hsu Email: tim.hsu@arcadis-us.com <br />CERS ID: 10186781 <br />Facility [Din CERS: FA0018143 <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Owner ID <br />OW0014886 <br />Owner name <br />HD Supply Distribution Services, LLC. <br />Home Depot U.S.A dba Crown Bolt <br />111 <br />Mailing address <br />3100 Cumberland Blvd., MS -1226 <br />2455 Paces Ferry Rd, C-19 <br />113 <br />Atlanta, GA 30339 <br />Atlanta, GA 30339 <br />114, 115, 116 <br />Work phone <br />770-822-9000 <br />770433-8211 X82714 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0018143 <br />Facility name <br />HD Supply Distribution Services, LLC <br />Home Depot USA, Inc. <br />3 <br />Site address <br />2055 INDUSTRAIL DR <br />2055 Industrial Drive <br />103 <br />City <br />Stockton <br />Stockton <br />104 <br />ZIP code <br />95206 <br />95206 <br />105 <br />Facility phone <br />404-653-5433 <br />404-653-5433 <br />102 <br />Facility mailing address <br />2055 Industrial Drive <br />160 Chapel Road, Suite 201 c/o Complian 108a <br />Stockton, CA 95206 <br />Manchester, CT 06042 <br />1084, 108c, 108d <br />131�� IrC�l1Tl��7� i'il�h iC�] ►J <br />Contact name Dave O'Donnell <br />Address 3100 Cumberland Blvd., Suite 1700, MS -12, <br />Atlanta, GA 30339 <br />Contact phone 404-653-5433 <br />Contact email david_odonnell@crownbolt.com <br />Mail invoices to Account Aa2-Do 3 1 q 13 <br />ARCADIS U.S., Inc. 140 <br />160 Chapel Road, Suite 201 C/O Complial 143 <br />Manchester, CT 06042 144, 145, 146 <br />8606451084 141 <br />Tierlladministrator@arcadis-us.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: Ulf Date: 4' 2- . ( <br />Accounting: Reviewed by: Date: 12t IS Clerical: File [ ] Relabel file [ ] Create new file <br />[ Acct billed [ Surcharge verified &db -A. By: Date: <br />----------�-------------------------------- - ---- <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location PR0526786 ROBERT LOPEZ Inactive/ -Ali[ ] <br />2220 - SM HW GEN <5 TONS/YR PRO538428 STACY RIVERA Inactive [ ] <br />4740 - WASTE TIRE SITE - EXEMPT PR0535050 ALFONSO ARAMBULA Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0533466 not assigned Inactive [ ] [ ] <br />