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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 2/17/2016 <br />Submitted on: 2/1/2016 7:59:13PM CERS ID: 10657183 <br />Submitted by: Amritpal Tiwana Email: tiwanasubs@gmail.com Facility ID in CERS: incorrect <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW pro( <br />(current EC database) <br />Number of Facilities for this Owner <br />OW0003612 <br />TIWANA, AMRITPAL S <br />5300 QUASHNICK RD <br />STOCKTON, CA 95212 <br />209-482-2580 <br />FACILITY FILE INFORMATION <br />Information after CIW processing <br />(current submittal) <br />Vin Tiwana <br />5500 Quashnick Rd <br />Stockton, CA 95212 <br />209-298-6629 <br />CERS <br />field <br />111 <br />113 <br />114, 115, 116 <br />112 <br />Facility ID <br />FA0023294 <br />Address 5500 QUASHNICK RD 5500 Quashnick Rd <br />143 <br />Facility name <br />SUBWAY SANDWICHES & SALADS #6521 <br />Subway # 65214 /� <br />3 <br />Site address <br />2828 COUNTRY CLUB BLVD STE 102 <br />2828 Country Club Blvd 10 <br />103 <br />City <br />STOCKTON <br />Stockton <br />104 <br />ZIP code <br />95204 <br />95204 <br />105 <br />Facility phone <br />209-415-3985 <br />209-298-6629 <br />102 <br />Facility mailing address <br />5500 QUASHNICK RD <br />5500 Quashnick Rd <br />108a <br />------ <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />ACTIVE <br />STOCKTON, CA 95212 <br />Stockton, CA 95212 <br />108b, 108c, 1084 <br />BILLING INFORMATION <br />Contact name SUBWAY SANDWICHES & SALADS #6521 Vin Tiwana <br />140 <br />Address 5500 QUASHNICK RD 5500 Quashnick Rd <br />143 <br />STOCKTON, CA 95212 Stockton, CA 95212 <br />144, 145, 146 <br />Contact phone 209-482-2580 209-298-6629 <br />141 <br />Contact email tiwanasubs@gmail.com <br />142 <br />Mail invoices to Facility <br />Program record HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br />�' 1 <br />Assigned to: <br />S R� <br />Please bill: full calendar year [ ] prorate this calendar year [ ] next calendar year [ <br />] exempt from billing <br />^^II <br />Processed through CERS Integration Wizard by: Date: <br />-------------------------------------------------- <br />Accounting: Re iewed by: t/f�? Date: Clerical: [ ] File [ ] Relabel <br />file [ ] Create new file <br />[ Acct billed [ Surcharge vedfiedd _By:_ <br />— ------------------------------------------ <br />----� ----- <br />_ Date_ — _ - <br />-- <br />------ <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />ACTIVE <br />Program Element and Description Record ID Employee name Status <br />Reactivated Inactivated <br />1623 - RESTAURANT/BAR 1-20 SEATS PR0540754 MARIBEL FLOHRSCHUTZ Active <br />I I I I <br />[4tv P -V311 <br />