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SAN JOAQUi. BOUNTY ENVIRONMENTAL HEALTh jEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/9/2015 <br /> Submitted on: 4/6/2015 4:42:14PM CERS ID: 10181591 <br /> Submitted by: Armando Padilla Email: armando@ghaimanagement.com Facility ID in CERS: FA0004108 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0005503 <br /> Owner name Quikserve Enterprises INC Sunny Ghai 111 <br /> Mailing address 1904 Via di Salerno 1904 Via di Salerno 113 <br /> Pleasanton, CA 94566 Pleasanton, CA 94566 114, 115, 116 <br /> Work phone 209-367-7693 5103337802 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004108 <br /> Facility name BURGER KING#7628 BURGER KING #7628 3 <br /> Site address 18960 N HWY 88 18960 N HWY 88 103 <br /> City LOCKEFORD LOCKEFORD 104 <br /> ZIP code 95237 95237 105 <br /> Facility phone 209-367-7693 5105088934 102 <br /> Facility mailing address 1904 VIA DI SALERNO 633 E VICTOR RD 108a <br /> PLEASANTON, CA 94566-2117 LODI, CA 95240 108b, 108c, 108d <br /> BILLING INFORMATION <br /> Contact name BURGER KING#7628 Sunny Ghai 140 <br /> Address 1904 VIA DI SALERNO 18960 N HWY 88 143 <br /> PLEASANTON, CA 94566-2117 LOCKEFORD, CA 95237 144, 145, 146 <br /> Contact phone Not Specified 5103337802 141 <br /> Contact email sunny@ghaimanagement.com 142 <br /> Mail invoices to Fa � Ity <br /> Program record [ ] H BP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: Date: 46-3 f/5 <br /> Accounting: Reviewed by: b1b Date: �(�3 15 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 /> 1624-RESTAURANT/BAR 21-50 SEATS PRO163398 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0520747 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO511203 HAZ MAT SJC OES Inactive [ J [ J <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532429 not assigned Inactive [ ] [ J <br />