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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run' 6/14/2016 <br />Submitted on: 6/2/2016 8:07:59AM <br />Submitted by: Paul Hastings Email: phastings@chipotle.com <br />CERS ID: 10404961 <br />Facility ID in CERS: FA0018861 <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 />Number of Facilities for this Owner: 4 <br />Owner ID <br />OW0012304 <br />Owner name <br />CHIPOTLE MEXICAN GRILL INC <br />Chipotle Mexican Grill, Inc <br />111 <br />Mailing address <br />1401 WYNKOOP ST STE #500 <br />1401 Wynkoop Street Suite 500 <br />113 <br />DENVER, CO 80202-1127 <br />Denver, CO 80202 <br />114, 115, 116 <br />Work phone <br />303-595-4000 <br />(303) 595-4000 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0018861 <br />Facility name <br />Chipotle Mexican Grill <br />Chipotle Mexican Grill #1134 <br />3 <br />Site address <br />1442 Hulsey Way <br />1442 Hulsey Way <br />103 <br />City <br />Manteca <br />Manteca <br />104 <br />ZIP code <br />95336 <br />95336 <br />105 <br />Facility phone <br />303-595-4000 <br />(303) 595-4000 <br />102 <br />Facility mailing address <br />1401 Wynkoop Street, Suite 500 <br />1401 Wynkoop Street, Suite 500 <br />108a <br />Denver, CO 80202 <br />Denver, CO 80202 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name <br />Chipotle Mexican Grill, Inc <br />Chipotle Mexican Grill, Inc <br />140 <br />Address <br />1401 Wynkoop Street Suite 500 <br />1401 Wynkoop Street Suite 500 <br />143 <br />Denver, CO 80202 <br />Denver, CO 80202 <br />144, 145, 146 <br />Contact phone <br />303-595-4000 <br />(303) 595-4000 <br />141 <br />Contact email <br />licensing@chipotle.com <br />licensing@chipotle.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: a —Date: o%r-,/(4/[� <br />Accounting: Reviewed by: Lt) Date: "07/s I / to Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />--------------------------------------------------- <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 PR0527825 KADEANNE LINHARES Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility PR0540064 KADEANNE LINHARES Active [ ] [ ] <br />