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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: 3/10/2017 10:52:30AM CERS ID: 10720666 <br />Submitted by: Joanne Wilson Email: jwilson@nationsrestaurants.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 />OW0022182 <br />NATIONS GIANT HAMBURGERS NO 30 A <br />11090 SAN PABLO AVE <br />EL CERRITO, CA 94530 <br />FACILITY FILE INFORMATION <br />Facility ID in CERS: FA0001927 <br />Information after CIW processing CERS <br />(current submittal) field <br />Nation's Foodservice, Inc. 111 <br />11090 San Pablo Avenue 113 <br />EI Cerrito, CA 94530 114, 115, 116 <br />510-237-1952 112 <br />Facility ID <br />FA0001927 <br />David Ballot, Nation's Foodservice, Inc. <br />140 <br />Facility name <br />NATIONS GIANT HAMBURGERS (STKN) <br />NATIONS GIANT HAMBURGERS (STOCKTC <br />3 <br />Site address <br />3333 W HAMMER Ln <br />3333 W Hammer Ln <br />103 <br />City <br />STOCKTON <br />Stockton <br />104 <br />ZIP code <br />95219 <br />95219 <br />105 <br />Facility phone <br />209-477-5922 <br />209-477-5922 <br />102 <br />Facility mailing address <br />11090 SAN PABLO AVE <br />11090 San Pablo Avenue <br />108a <br />EL CERRITO, CA 94530 <br />EI Cerrito, CA 94530 108b, 1oac, 10sd <br />BILLING INFORMATION <br />Contact name <br />NATIONS GIANT HAMBURGERS (STKN) <br />David Ballot, Nation's Foodservice, Inc. <br />140 <br />Address <br />11090 SAN PABLO AVE <br />11090 San Pablo Avenue <br />143 <br />1919 - HMBP-0O2 Only Food Facility 1 chem units <br />EL CERRITO, CA 94530 <br />EI Cerrito, CA 94530 <br />144, 145, 146 <br />Contact phone <br />Not Specified <br />510-237-1952 <br />141 <br />Contact email <br />PR0511161 <br />dballot@nationsrestaurants.com <br />142 <br />Mail invoices to <br />Account <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. 0,,^', P-, Date: q -al 1-7 <br />----------------------------------------------- <br />Accounting: Reviewed by: D6 Date: 5I3I17 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1625 - RESTAURANT/BAR 51-100 SEATS <br />PRO160135 <br />STEPHANIE RAMIREZ <br />Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units <br />PR0520711 <br />STEPHANIE RAMIREZ <br />Active [ ] [ ] <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0513449 <br />HAZ MAT SJC OES <br />Inactive [ ] [ 1 <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PR0511161 <br />HAZ MAT SJC OES <br />Inactive [ ] [ ] <br />