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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 11/6/2014 <br /> Submitted on: 9/29/2014 1:03:26PM CERS ID: 10505809 <br /> Submitted by: Chris Baker Email: Chris.Baker@stericycle.com Facility ID in CERS: FA0002178 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001693 <br /> Owner name ROSS STORES INC Ross Dress For Less Inc. 111 <br /> Mailing address 5130 HACIENDA DR 3RD FLOOR 5130 Hacienda Dr 113 <br /> DUBLIN, CA 94568-7579 Dublin, CA 94568-7579 114, 115, 11E <br /> Work phone Not Specified 925-965-4831 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002178 <br /> Facility name ROSS STORES INC#035 Ross Dress For Less#0035 3 <br /> Site address 5756 PACIFIC AVE STE 60 5756 Pacific Ave Ste 60 103 <br /> City STOCKTON Stockton 104 <br /> Zip code 95207 95207 105 <br /> Facility phone Not Specified 209-957-6202 102 <br /> Facility mailing address 5130 HACIENDA DR 3RD FL 5130 Hacienda Dr 108a <br /> DUBLIN, CA 94568-7579 Dublin, CA 94568-7579 108b, 106c,10e <br /> BILLING INFORMATION <br /> Contact name ROSS STORES INC#035 Sean Hewitt 140 <br /> Address 5130 HACIENDA DR 3RD FL 5130 Hacienda Dr 143 <br /> DUBLIN, CA 94568-7579 Dublin, CA 94568-7579 144, 145, 14( <br /> Contact phone Not Specified 925-965-4113 141 <br /> Contact email sean.hewitt@ros.com 142 <br /> Mail invoices to Fazffity,/1✓ <br /> Program record [ ] HMBP [k] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: C)S' 9s1Z <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 22 Z6 <br /> Assigned to: zc' e <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendarear <br /> y [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: f,I I Date: IID J(, I ILI <br /> Accounting: Reviewed by: ��Date: Clerical: [>] File [ ] Relabel file [kr Create new file <br /> [ ] A�illed [ ] Surc ve Ifi�ed — By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1620-RETAIL MKT 26-300 SQ FT(INCIDENTAL FOODS) PRO163334 MARI BEL FLOHRSCHUTZ Active ( ] [ ] <br />