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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/6/2017 <br /> Submitted on: 6/25/2017 5:53:50PM CERS ID: 10737937 <br /> Submitted by: Chris Ray Email: mbuettner@parkwestcasinos.com <br /> Facility ID in CERS: incorrect <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 OW0005700 <br /> Owner name LODI CARDROOM INC JOHN PARK 111 <br /> Mailing address PO BOX 2734 1100 S Flower St., Suite 3100 113 <br /> LODI, CA 95241 Los Angeles, CA 90015 114, 115, 116 <br /> Work phone 3234154901 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006940 <br /> Facility name LODI CASINO Parkwest Casino Lodi 3 <br /> Site address 1800 S CHEROKEE LN 1800 S Cherokee Ln 103 <br /> City LODI Lodi 104 <br /> ZIP code 95240 95240 105 <br /> Facility phone 209-369-4150 2092634112 102 <br /> Facility mailing address PO BOX 2734 1100 S Flower St., Suite 3100 108a <br /> LODI, CA 95241 Los Angeles, CA 90015 108b, 108c,10ad <br /> BILLING INFORMATION <br /> Contact name Parkwest Casino EMMET BAYOG 140 <br /> Address PO BOX 2367 1100 S Flower St., Suite 3100 143 <br /> LODI, CA 95242 Los Angeles, CA 90015 144, 145, 146 <br /> Contact phone Not Specified 3234154917 141 <br /> Contact email ebayog@fortiss.com 142 <br /> Mail invoices to Facility <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: [ J full calendar year [ ] prorate this calendar year [ ] next calendarear <br /> �] y [ ] exempt from billing <br /> (n�, <br /> Processed through CERS Integration Wizard by: f FJytn P9-- Date: <br /> Accounting: Reviewed by: Date: -71,911-1 <br /> Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1626-RESTAURANT/BAR 101 +SEATS PRO505676 JEFFREY WONG Active [ ] [ ] <br /> 1919-HMBP-0O2 Only Food Facility 1 Chem units PRO542002 JEFFREY WONG Active [ ] [ ] <br />