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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/27/2017 <br />Submitted on: 2/28/2017 10:53:26AM <br />Submitted by: BETH GRUBA Email: bethg@harmans.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 />OW0021719 <br />GARNER 120 INC <br />5544 S GREEN ST <br />MURRAY. UT 84123 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023475 <br />Facility name <br />KENTUCKY FRIED CHICKEN <br />Site address <br />2712 W KETTLEMAN LN <br />City <br />LODI <br />ZIP code <br />95240 <br />Facility phone <br />916-812-2803 <br />Facility mailing address <br />5544 S GREEN ST <br />MURRAY, UT 84123 <br />BILLING INFORMATION <br />Contact name <br />KENTUCKY FRIED CHICKEN <br />Address <br />2712 W KETTLEMAN LN <br />LODI, CA 95240 <br />Contact phone <br />Not Specified <br />Contact email <br />Mail invoices to <br />Account <br />CERS ID: 10728745 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Garner 120, Inc. 111 <br />1555 Meadowview Road, Suite 150 113 <br />Sacramento, CA 95832 114, 115, 116 <br />916-553-2267 112 <br />KENTUCKY FRIED CHICKEN #120 (LODI, C, 3 <br />2712 W Kettleman Ln 103 <br />Lodi 104 <br />95242 105 <br />209-368-2234 102 <br />1555 Meadowview Road, Suite 150 108a <br />Sacramento, CA 95832 108b. 108c, 108d <br />Garner 120, Inc. 140 <br />1555 Meadowview Road, Suite 150 143 <br />Sacramento, CA 95832 144, 145, 146 <br />916-553-2267 141 <br />bethg@harmans.com 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LOG 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: 0,9 VK Date: <br />Accounting: Reviewed by: _ Dater Clerical: [ ] File [ ] Relabel file [ ] Create new file <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 />1625 - RESTAURANT/BAR 51-100 SEATS PR0541010 STEPHANIE RAMIREZ Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PRO541529 STEPHANIE RAMIREZ Active [ ] [ ] <br />