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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 10/12/2015 Submitted on: 10/7/2015 2:16:11AM CERS ID: 10642354 Submitted by: Jim Toal Email: team@wingsinmotion.net Facility ID in CERS: incorrect Program record [ J HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: Date: Accounting: Reviewed by: tf-'-' Date: �Dr `3�� Clerical: [ ] File [ ] Relabel file [ J Create new file [ ] Acct billed [ ] Surcharge verified By: Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 1624 - RESTAURANT/BAR 21-50 SEATS PRO163335 MELISSA NISSIM Active [ ] [ ] 1921 - HMBP-Regular-Primary Location PR0540318 PETER LOMBARD] Active [ ] [ ] Information prior to CIW processing Information after CIW processing CERS OWNER INFORMATION (current EC database) (current submittal) field Owner ID OW0016033 Owner name WINGS IN MOTION INC Wings In Motion, Inc 111 Mailing address 1063 CHESHIRE CIR 1988 W 11th St 113 DANVILLE, CA 94506 Tracy, CA 95376 114, 115, 116 Work phone 925-260-3605 3�*�0A� 209-985-5700 112 FACILITY FILE INFORMATION Facility ID FA0002984 Facility name WINGSTOP Wing Stop Tracy 3 Site address 1988 W ELEVENTH ST 1988 W 11th St 103 City TRACY Tracy 104 ZIP code 95376 95376 105 Facility phone 209-836-9464 2098369464 102 Facility mailing address 2612 BARLOA LN 2612 Barola Ln 108a MODESTO, CA 95356 Modesto, CA 95356 108b, 108c, 108d BILLING INFORMATION Contact name WINGSTOP Robin Veltheon 140 Address 2612 BARLOA LN 3608 Corte Madera Ave. 143 MODESTO, CA 95356 Modesto, CA 95356 144, 145, 146 Contact phone 209-836-9464 209-479-4455 141 Contact email robin.springcreek@gmail.com 142 Mail invoices to Facility Program record [ J HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: Date: Accounting: Reviewed by: tf-'-' Date: �Dr `3�� Clerical: [ ] File [ ] Relabel file [ J Create new file [ ] Acct billed [ ] Surcharge verified By: Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Program Element and Description Record ID Employee name Status Reactivated Inactivated 1624 - RESTAURANT/BAR 21-50 SEATS PRO163335 MELISSA NISSIM Active [ ] [ ] 1921 - HMBP-Regular-Primary Location PR0540318 PETER LOMBARD] Active [ ] [ ]