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SAN JOAQU{�COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/20/2014 <br /> Submitted on: 3/7/2014 1:27:53PM 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 /> Owner ID OW0006094 <br /> Owner name CONLEY 206 INC HARMAN-CONLEY INC 111 <br /> Mailing address PO BOX 572530 5544 GREEN ST 113 <br /> SALT LAKE CITY, UT 84157-2530 SALT LAKE CITY, UT 84123-5798 114, 115, 116 <br /> Work phone 650-941-5681 209-478-5754 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 952092737 95209-2737 105 <br /> Facility phone 209-478-5754 (209)478-5754 102 <br /> Facility mailing address PO BOX 572530 8334 GERBER RD 108a <br /> SALT LAKE CITY, UT 84157-2530 SACRAMENTO, CA 95828-3710 108b,to8c,toed <br /> BILLING INFORMATION <br /> Contact name KENTUCKY FRIED CHICKEN #206 KENTUCKY FRIED CHICKEN#206 140 <br /> Address PO BOX 572530 P.O. BOX 572530 143 <br /> SALT LAKE CITY, UT 84157-2530 SALT LAKE CITY, UT 84157 144, 145, 146 <br /> Contact phone Not Specified 801-313-8000 141 <br /> Contact email 142 <br /> Mail invoices to ZaeiHtq-j7lp, J <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: � (2-* (t`f <br /> --- ----- — -- ----------------------- <br /> Accounting. —,(m <br /> Reviewed by: Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] <br /> Agel5illecl [ ] S rge v rifled By: Date: <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 PR016 8840 VIDAL PEDRAZA Active <br /> 1921.-HMBP-Regular-Primary Location PRO520988 LOWELL ALLEN Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO517654 JOHNNY YOAKUM Inactive [ ] [ ] <br />