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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/21/2016 <br /> Submitted on: 12/6/2016 4:18:59PM CERS ID: 10719076 <br /> Submitted by: anay reyes Email: areyes@encore.bz 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 OW0022064 <br /> Owner name Dale DoerhoffDale Doerhoff 111 <br /> Mailing address 5005 LBJ Freeway, Suite 1200 5005 LBJ Freeway, Suite 1200 113 <br /> Dallas, TX 75244 Dallas, TX 75244 114, 115, 116 <br /> Work phone 214-259-2490 2142592490 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0023728 <br /> Facility name Five Guys Manteca Five Guys Manteca 3 <br /> Site address 2140 Daniels St 2140 Daniels St 103 <br /> City Manteca Manteca 104 <br /> ZIP code 95337 95337 105 <br /> Facility phone 209-923-6106 209.923.6106 102 <br /> Facility mailing address 2140 Daniels Street 2140 Daniels Street 108a <br /> Manteca, CA 95337 Manteca, CA 95337 108b, 10ac,10sd <br /> BILLING INFORMATION <br /> Contact name Five Guys GM Five Guys GM 140 <br /> Address 2140 Daniels Street 2140 Daniels Street 143 <br /> Manteca, CA 95337 Manteca, CA 95337 144, 145, 146 <br /> Contact phone 209-923-6106 209.923.6106 141 <br /> Contact email FG1801@encore.bz FG1801@encore.bz 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA <br /> [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ j prorate this 11 ndar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: La/((a <br /> Accounting: Reviewed by: �r�J Date: IiI/ Clerical: File <br /> [ ] [ ] 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 /> 1625-RESTAURANT/BAR 51-100 SEATS PR0541409 KADEANNE LINHARES Active [ ] ( ] <br /> 1919-HMBP-0O2 Only Food Facility 6 chem units PR0541410 KADEANNE LINHARES Active [ ] [ ] <br />