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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 10/20/2016 <br /> Submitted on: 10/19/2016 8:02:19AM CERS ID: 10182091 <br /> Submitted by: Salvador buenrostro Email: sa17410@att.net Facility ID in CERS: FA0006386 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0001207 <br /> Owner name BUENROSTRO, SALVADOR BUENROSTRO, SALVADOR 111 <br /> Mailing address 2717 ANGEL DR 2717 ANGEL DR 113 <br /> STOCKTON, CA 95209 stockton, CA 95203 114, 115, 116 <br /> Work phone 209-464-9707 209 271 1741 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006386 <br /> Facility name CALIFORNIA CATERING TRUCK WASH CALIFORNIA CATERING TRUCK WASH 3 <br /> Site address 730 S CALIFORNIA ST 730 S CALIFORNIA ST 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95203 95203 105 <br /> Facility phone 209-464-9707 (209) 464-9707 ✓ 102 <br /> Facility mailing address 730 S CALIFORNIA ST 730 S CALIFORNIA ST 108a <br /> STOCKTON, CA 95203 STOCKTON, CA 95203 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name CALIFORNIA CATERING TRUCK WASH CALIFORNIA CATERING TRUCK WASH 140 <br /> Address 730 S CALIFORNIA ST 730 s. california st. 143 <br /> STOCKTON, CA 95203 Stockton, CA 95203 144, 145, 146 <br /> Contact phone 209-464-9707 2092711741 ✓ 141 <br /> Contact email sa17410@att.net 142 <br /> Mail invoices to Owner <br /> Program record [ j 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: Date: <br /> Accounting: Reviewed by: SurcDate: [t) 2� [(v Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed harge 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 /> 1680-COMMISSARY(MFPU&FOOD PREP) 1/TJ 41WPR0504885 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br /> 1920-HMBP-Common Materials II1� PR0522039 ROBERT LOPEZ Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURC GE FI PR0532446 not assigned Inactive [ ] [ ] <br />