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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 3/17/2015 <br /> Submitted on: 3/12/2015 11:28:29AM CERS ID: 10156541 <br /> Submitted by: Larissa Colli Email: carissa.souza@safeway.com <br /> Facility ID in CERS: FA0000838 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0009310 <br /> Owner name Safeway, Inc. Safeway, Inc. 111 <br /> Mailing address 5918 Stoneridge Mall Rd. 5918 Stoneridge Mall Rd. 113 <br /> Pleasanton, CA 94588 Pleasanton, CA 94588 114, 115,116 <br /> Work phone 925-467-3000 925-467-3000 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000838 <br /> Facility name Safeway 3124 Safeway 3124 3 <br /> Site address 1187 S MAIN ST 1187 S Main St 103 <br /> City Manteca Manteca 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 925-467-3000 925-467-3000 102 <br /> Facility mailing address PO Box 29096, MS 6516 PO Box 29096, MS 6516 108a <br /> Phoenix, AZ 85038 Phoenix, AZ 85038 toab,toac.load <br /> BILLING INFORMATION <br /> Contact name SAFEWAY INC Kahty Hjelm 140 <br /> Address PO Box 29096, MS 6516 PO Box 29096, MS 6516 143 <br /> Phoenix, AZ 85038 Phoenix, AZ 85038 144, 145, 146 <br /> Contact phone 623-869-3577 623-869-3577 141 <br /> Contact email kathy.hjelm@safeway.com kathy.hjelm@safeway.com 142 <br /> Mail invoices to Account <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 [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> -------------- -------------------------------- -- - <br /> Accountin . Reviewed by: bf!> Date: 3 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 Inactivated <br /> 1921 -HMBP-Regular-Primary Location PRO538962 MICHAEL PARISSI Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0538961 MICHELLE HENRY Active [ ] [ ] <br />