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SAN JOAQUWOUNTY ENVIRONMENTAL HEALT EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 2/9/2015 <br /> Submitted on: 1/6/2015 3:25:41 PM CERS ID: 10182123 <br /> Submitted by: Jeffrey Helmrich Email:jhelmrich@innout.com Facility ID in CERS: FA0006595 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0005335 <br /> Owner name IN N OUT BURGER INC IN N OUT BURGER INC 111 <br /> Mailing address 4199 CAMPUS DR 9TH FLOOR 4199 Campus Drive 113 <br /> IRVINE, CA 91706 Irvine, CA 92612 114, 115, 116 <br /> Work phone 626-813-8200 949-509-6300 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006595 <br /> Facility name IN N OUT BURGER#96 IN N OUT BURGER#96 3 <br /> Site address 575 W CLOVER RD 575 W CLOVER RD 103 <br /> City Tracy TRACY 104 <br /> ZIP code 95376 95376 105 <br /> Facility phone 209-833-3569 949-509-6200 102 <br /> Facility mailing address 4199 CAMPUS DR 9TH FLOOR 4199 CAMPUS DR 9TH FLOOR 108a <br /> IRVINE, CA 92612 IRVINE, CA 92612 108b,1080,108d <br /> BILLING INFORMATION <br /> Contact name IN N OUT BURGER#96 Accounts Payable IN N OUT BURGER#96 Accounts Payable 140 <br /> Address 4199 CAMPUS DR 9TH FLOOR 4199 CAMPUS DR 9TH FLOOR 143 <br /> IRVINE, CA 92612 IRVINE, CA 92612 144, 145, 146 <br /> Contact phone 949-509-6200 949-509-6200 141 <br /> Contact email apinquirey@innout.com p ✓ apinquirey@innout.com 142 <br /> Mail invoices to I awmy/ T� <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: ()b \^ Date: 1.-" <br /> �7-------- --------------- <br /> Accounting: Reviewed by: N Date: 366 11 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 /> 1625-RESTAURANT/BAR 51-100 SEATS PRO505178 MELISSA NISSIM Active [ ] [ 1 <br /> 1921 -HMBP-Regular-Primary Location PRO520672 MICHAEL PARISSI Active [ 1 [ 1 <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO511105 HAZ MAT SJC OES Inactive [ 1 I 1 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532535 not assigned Inactive [ ] [ ] <br />