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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 9/9/2015 <br />Submitted on: 9/3/2015 2:16:57PM <br />CERS ID: 10642099 <br />Submitted by: Anand Kotecha <br />Email: cklathrop@comcast.net <br />Facility ID in CERS: <br />incorrect <br />City <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Owner ID <br />OW0006000 <br />Mail invoices to <br />Facility <br />Owner name <br />PATEL, BALU K <br />Anand Kotecha <br />111 <br />Mailing address <br />4127 BOULDER CR <br />14725 S Harlan Road <br />113 <br />STOCKTON, CA 95219 <br />Lathrop, CA 95330 <br />114, 115, 116 <br />Work phone <br />209-982-1959 <br />(209) 679-1073 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0012489 <br />Facility name <br />COUNTRY KITCHEN <br />Site address <br />14725 S HARLAN RD <br />City <br />LATHROP <br />ZIP code <br />95330 <br />Facility phone <br />209-983-8881 <br />Facility mailing address <br />14725 S HARLAN RD <br />14725 S Harlan Road <br />LATHROP, CA 95330 <br />BILLING INFORMATION <br />144, 145, 146 <br />Contact name <br />COUNTRY KITCHEN <br />Address <br />14725 S HARLAN RD <br />LATHROP, CA 95330 <br />Contact phone <br />209-983-8881 <br />Contact email <br />Mail invoices to <br />Facility <br />CK Grill & Bar 3 <br />14725 S Harlan Rd 103 <br />Lathrop 104 <br />95330 105 <br />(209) 983-8881 102 <br />14725 S Harlan Road 108a <br />Lathrop, CA 95330 108b, 108c, 108d <br />Anand Kotecha <br />140 <br />14725 S Harlan Road <br />143 <br />Lathrop, CA 95330 <br />144, 145, 146 <br />(209) 679-1073 <br />141 <br />cklathrop@comcast. net <br />142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: ` °" Date: C(� <br />Accounting: Reviewed by: Lb Date: y/"// S Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[� Arrt hilled r I Surcharge 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 />1626 - RESTAURANT/BAR 101 + SEATS PR0516157 MELISSA NISSIM Active [ J [ ] <br />1921 - HMBP-Regular-Primary Location PR0540358 PETER LOMBARDI Active [ ] [ ] <br />Oer J. C. RP A6 C //* <br />