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SAN JOAQUIN-r:OUNTY ENVIRONMENTAL HEALTH110tPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/20/2014 <br /> Submitted on: 6/3/2014 10:36:18AM CERS ID: 10180893 <br /> Submitted by: Roger Batra Email: roger.batra@quikstop.com Facility ID in CERS. FA0002232 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000478 <br /> Owner name QUIK STOP MARKETS INC QUIK STOP MARKETS INC 111 <br /> Mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 113 <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 114, 115, 116 <br /> Work phone 510-657-8500 510-657-8500 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002232 <br /> Facility name QUIK STOP MARKET#3132* QUIK STOP MARKET#3132* 3 <br /> Site address 3555 W HAMMER LN 3555 W HAMMER LN 103 <br /> City Stockton STOCKTON 104 <br /> Zip code 95219 95209 105 <br /> Facility phone 209-951-3195 (209) 951-3195 102 <br /> Facility mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 108a <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 108b,ioac,108d <br /> BILLING INFORMATION <br /> Contact name QUIK STOP MARKET#3132* QUIK STOP MARKET#3132* 140 <br /> Address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 143 <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 144, 145,146 <br /> Contact phone 510-445-2285 510-445-2285 141 <br /> Contact email mike.karvelot@quikstop.com roger.batra@quikstop.com 142 <br /> Mail invoices to Facility J <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: v Date: ('1t ) <br /> --------------- ----------------------- <br /> Accounting: Reviewed by: L.L—Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acc "led [ ] Suroven led _--------By:—_ Date_ <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> ,Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1617-RETAIL MARKET>1000 SO FT W/FOOD PREP PRO160303 NICHOLAS WIESEMAN Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0519800 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN 45 TONS/YR PRO526835 Fatina Zareef Active [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PRO515541 MICHAEL KITH Inactive [ ] [ ] <br /> 2361 -UST FACILITY PR0231130 Fatina Zareef Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507297 MICHAEL KITH Inactive [ ] [ ] <br />