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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run' 7/10/2017 <br />Submitted on: 7/6/2017 3:08:30PM <br />Submitted by: Dana Acton Email: danaacton@southernwine.com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner : 1 <br />OW0016175 <br />SOUTHERN WINE & SPIRITS <br />33321 DOWE AVE <br />UNION CITY, CA 94587 <br />510-477-5500 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0019718 <br />Facility name <br />SOUTHERN WINE & SPIRITS <br />Site address <br />1918 INDUSTRIAL DR <br />City <br />STOCKTON <br />ZIP code <br />95206 <br />Facility phone <br />209-983-0155 <br />Facility mailing address <br />1918 INDUSTRIAL DR <br />STOCKTON, CA 95206 <br />BILLING INFORMATION <br />Contact name <br />Brandon Hoffman <br />Address <br />33321 DOWE AVE <br />UNION CITY, CA 94587 <br />Contact phone <br />510-477-5500 <br />Contact email <br />brandonhoffman@southernwine.com <br />Mail invoices to <br />Account <br />CERS ID: 10187357 <br />Facility ID in CERS: FA0019718 <br />Information after CIW processing CERS <br />(current submittal) field <br />SOUTHERN WINE & SPIRITS 111 <br />33321 DOWE AVE 113 <br />UNION CITY, CA 94587 114, 115, 116 <br />(510) 477-5500 112 <br />Southern Glazers Wine and Spirits Stocktoi 3 <br />1918 INDUSTRIAL DR <br />103 <br />STOCKTON <br />104 <br />95206 <br />105 <br />(209) 983-0155 0 <br />102 <br />1918 INDUSTRIAL DR <br />108a <br />STOCKTON, CA 95206 <br />108b, 10ac, 10ad <br />Brandon Hoffman 140 <br />33321 DOWE AVE 143 <br />UNION CITY, CA 94587 144, 145, 146 <br />(510) 477-5500 141 <br />brandonhoffman@southernwine.com 142 <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: ' "`�N" Date: _7_k2_0 <br />Accounting: Reviewed by: V-2 Date: Mill <br />7 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 />Record ID Employee name Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location 1 chem units PR0529881 ROBERT LOPEZ Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0533122 not assigned Inactive [ ] [ ] <br />