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AM <br /> SAN JOAQUI,1 OUNTY ENVIRONMENTAL HEALT PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/27/2014 <br /> Submitted on: 3/7/2014 2:54:54PM CERS ID: 10184709 <br /> Submitted by: BETH GRUBA Email: bethg@harmans.com Facility ID in CERS: FA0014570 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0006093 <br /> Owner name COOLEY 200 INC HARMAN-COOLEY INC 111 <br /> Mailing address PO BOX 572530 8334 GERBER ROAD 113 <br /> SALT LAKE CITY, UT 84157-2530 SACRAMENTO, CA 9828 114, 115, 116 <br /> Work phone 650-941-5681 916-689-2190 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014570 <br /> Facility name KFC &AW HARMAN-COOLEY#200 KFC &AW HARMAN-COOLEY#200 3 <br /> Site address 3519 E HAMMER LN 3519 E HAMMER LN 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 952122821 95212-2821 105 <br /> Facility phone 209-952-7128 (209) 952-7128 102 <br /> Facility mailing address PO BOX 572530 8334 GERBER RD 108a <br /> SALT LAKE CITY, UT 84157-2530 SACRAMENTO, CA 95828-371 / 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name KFC &AW HARMAN-COOLEY#200 KFC &AW HARMAN-COOLEY#200 140 <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 Fad< �7 <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG 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: U � Date: 2v (1,-(- <br /> Accounting: Reviewed by: Date: Clerical: File [ ] Relabel file [ ] Create new file <br /> [ 1 [ ] Sur ch a verified <br /> ----- -----------By.--- Date: <br /> ---- —A filled <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Emplovee name Status Reactivated Inactivated <br /> 1625-RESTAURANT/BAR 51-100 SEATS PR0521461 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0527145 HAZA SAEED Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531500 not assigned Inactive [ ] [ ] <br />