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Ak <br /> SAN JOAQUIK OUNTY ENVIRONMENTAL HEALTH PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 7/7/2014 <br /> Submitted on: 10/10/2013 1:23:45PM CERS ID: 10182329 <br /> Submitted by: Steve Martin Email: steve.martin@wendys.com Facility ID in CERS: FA0008023 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0006626 <br /> Owner name The Wendy's Company The Wendy's Company 111 <br /> Mailing address One Dave Thomas Blvd One Dave Thomas Blvd 113 <br /> Dublin, OH 43017 Dublin, OH 43017 114,115, 116 <br /> Work phone 614-764-3400 614-764-3400 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0008023 <br /> Facility name WENDYS INTERNATIONAL#2659 WENDYS INTERNATIONAL#2659 3 <br /> Site address 3810 E HAMMER LN 3810 E HAMMER LN 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 95212 95212 105 <br /> Facility phone 209-952-0333 (209) 952-0333 102 <br /> Facility mailing address One Davis Thomas Blvd One Davis Thomas Blvd 108a <br /> Dublin, OH 43017 Dublin, OH 43017 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name Mark Keller Mark Keller 140 <br /> Address One Dave Thomas Blvd One Dave Thomas Blvd 143 <br /> Dublin, OH 43017 Dublin, OH 43017 144, 145, 146 <br /> Contact phone 614-791-4302 614-791-4302 141 <br /> Contact email 142 <br /> Mail invoices to Facility <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: Date: <br /> -------------- -- ----------------- <br /> Accounting: Reviewed by:. Date: :D ) Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] A�billed [ ] Surc a verified 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 PRO508257 STEPHANIE RAMIREZ Active [ ] [ 1 <br /> 1921 -HMBP-Regular-Primary Location PRO520985 HAZA SAEED Active [ ] [ 1 <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0517648 RAYMOND BORGES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PRO533594 not assigned Inactive [ ] I 1 <br /> V <br />