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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/19/2016 <br /> Submitted on: 2/24/2016 3:36:51PM CERS ID: 10180827 <br /> Submitted by: BETH GRUBA Email: bethg@harmans.com Facility ID in CERS: FA0001886 <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 OW0006094 <br /> Owner name HARMAN-CONLEY INC Conley 206, Inc. 111 <br /> Mailing address 5544 GREEN ST 1555 Meadowview Road, Suite 150 113 <br /> SALT LAKE CITY, UT 84123-5798 Sacramento, CA 95823 114, 115, 116 <br /> Work phone 209-478-5754 916-553-2267 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001886 <br /> Facility name KENTUCKY FRIED CHICKEN #206 KENTUCKY FRIED CHICKEN #206 3 <br /> Site address 3264 W HAMMER LN 3264 W HAMMER LN 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95209-2737 95209-2737 105 <br /> Facility phone 209-478-5754 209-478-5754 102 <br /> Facility mailing address 8334 GERBER RD 1555 Meadowview Road, Suite 150 108a <br /> SACRAMENTO, CA 95828-3710 Sacramento, CA 95823 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name KENTUCKY FRIED CHICKEN #206 Conley 206, Inc. 140 <br /> Address P.O. BOX 572530 1555 Meadowview Road, Suite 150 143 <br /> SALT LAKE CITY, UT 84157 Sacramento, CA 95823 144, 145, 146 <br /> Contact phone 801-313-8000 916-553-2267 141 <br /> Contact email bethg@harmans.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] 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: <br /> Accounting: Reviewed by: Date: � D4 Ub Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> -------------------------------------------------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1625-RESTAURANT/BAR 51.100 SEATS PRO162840 VIDAL PEDRAZA Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0520988 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO517654 JOHNNY YOAKUM Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533904 not assigned Inactive [ ] [ ] <br />