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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 12/9/2016 <br /> Submitted on: 12/2/2016 11:22:11AM CERS ID: 10182211 <br /> Submitted by: Brad Stevens Email: bstevens@appleamerican.com Facility ID in CERS: FA0007151 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION Icurrent EC database) (current submittal) field <br /> Number of Facilities for this Owner: 2 <br /> Owner ID OW0016471 <br /> Owner name APPLE NORCAL LLC APPLE NORCAL LLC 111 <br /> Mailing address 6200 OAK TREE BLVD STE#250 6200 OAK TREE BLVD STE#250 113 <br /> Independence, OH 44131 Independence, OH 44131 114, 115,116 <br /> Work phone 216-525-2775 216-525-2775 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007151 <br /> Facility name APPLEBEES APPLEBEES 3 <br /> Site address 2442 W KETTLEMAN LN 2442 W KETTLEMAN LN 103 <br /> City LODI LODI 104 <br /> ZIP code 95242 95242 105 <br /> Facility phone 209-369-6657 (209) 369-6657 102 <br /> Facility mailing address 6200 OAK TREE BLVD STE#250 PO Box 507 108a <br /> CLEVELAND, OH 44131 West Linn, OR 97068 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name APPLEBEES Cheryl Mills 140 <br /> Address 6200 OAK TREE BLVD STE#250 PO Box 507 143 <br /> CLEVELAND, OH 44131 West Linn, OR 97068 144, 145, 146 <br /> Contact phone 209-239-6657 503-722-2825 141 <br /> Contact email cmills@appleamerican.com 142 <br /> Mail invoices to Account <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 thi le dar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: A Date: j 2 4f <br /> 1��51)to Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> Accounting: Reviewed by: Da—te: <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1626-RESTAURANT/BAR 101 +SEATS PR0506023 STEPHANIE RAMIREZ Active [ ] I ] <br /> 1919-HMBP-0O2 Only Food Facility 1 chem units PRO520727 STEPHANIE RAMIREZ Active [ ] [ 1 <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513469 HAZ MAT SJC DES Inactive [ ] ( ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511181 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO535267 not assigned Inactive [ ] [ ] <br />