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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/27/2017 <br />Submitted on: 4/15/2017 3:07:59PM <br />Submitted by: David Wanke Email: dm@mdrzinc.com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner : 1 <br />OW0021188 <br />DRMS Tracy Inc. <br />140 Mayhew Way Suite 801 <br />Pleasant Hill, CA 94523 <br />925-935-6357 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023093 <br />Facility name <br />Original Mels <br />Site address <br />2986 W GRANT LINE <br />City <br />Tracy <br />ZIP code <br />95304 <br />Facility phone <br />209-836-6071 <br />Facility mailing address 2986 W. Grant Line Rd <br />Tracy, CA 95304 <br />BILLING INFORMATION <br />Contact name <br />Sarah Callum <br />Address <br />140 Mayhew Way Suite 801 <br />PLEASANT HILL, CA 94523 <br />Contact phone <br />925-935-6357 <br />Contact email <br />accounting@mdrzinc.com <br />Mail invoices to <br />Account <br />CERS ID: 10725982 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />DRMS Tracy Inc. 111 <br />140 Mayhew Way Suite 801 113 <br />Pleasant Hill, CA 94523 114, 115, 116 <br />925-935-6357 112 <br />Original Mels 3 <br />2986 W Grant Line Rd 103 <br />Tracy 104 <br />95304 105 <br />209-836-6071 102 <br />2986 W. Grant Line Rd 108a <br />Tracy, CA 95304 108b, 10ac, 108d <br />Sarah Callum 140 <br />140 Mayhew Way Suite 801 143 <br />TT-dcy, CA 95364- ,, p�-�� , (,�4, 145, 146 <br />925-935-6357 �0 141 <br />accounting@mdrzinc.com "/Z3 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: <br />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: 00" Az- Date: <br />Accounting: Reviewed by: VFf Date: �y� Clerical: [ ] File [ ] 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 />1626 - RESTAURANT/BAR 101 + SEATS PR0540413 MELISSA NISSIM Active I ] I ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0541595 MELISSA NISSIM Active I ] I ] <br />