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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/31/201 <br /> Submitted on: 12/30/2014 4:01:04PM CERS ID: 10146199 <br /> Submitted by: Nicole Magner Email: Nicole.magner@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 ((425) <br /> stco Wholesale#38 3 <br /> Site address 1616 E Hammer Ln 16 E Hammer Ln 103 <br /> City Stockton ckton 104 <br /> ZIP code 95210 10 105 <br /> Facility phone 209-478-2040 9)478-2040 102 <br /> Facility mailing address PO Box 35005 stco Wholesale Attn: Licensing, PO Bc 108a <br /> Seattle, WA 98124-3405 attle, WA 98124-3405 10eb, 10ec, Toad <br /> BILLING INFORMATION <br /> Contact name Costco Wholesale#38 stco Wholesale Corporation, Environn 140 <br /> Address PO Box 35005 Lake Drive 143 <br /> Seattle, WA 98124-3405 aquah,WA 98027 144, 145, 146 <br /> Contact phone Not Specified 313-6110 141 <br /> Contact email ✓ L 142 <br /> Mail invoices to Account <br /> 00 <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: Ate_Date: 1t•3(-l� <br /> -- ---9. --- —y--- — ------- ----- ---- ----- <br /> Accountin Reviewed b : l�. Dater Clerical: N File [ ] Relabel file [ ] Create new file <br /> [ J Acct billed [ ] Surcharge verified 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 /> 1619-RETAIL MKT>1000 SO FT(=/>2 DEPTS) PRO160939 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0519873 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO517875 MICHELLE HENRY Active [ ] [ ] <br /> 2371 -UST FACILITY-1702 COMPLIANT PR0518624 FATINAH ZAREEF Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO522399 BENJAMIN ESCOTTO 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 /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO509785 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533728 not assigned Inactive [ ] [ ] <br />