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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 5/31/2017 <br />Submitted on: 5/24/2017 3:47:51 PM CERS ID: 10735411 <br />Submitted by: harwinder Singh Email: sppizzainc@hotmail.com Facility ID in CERS: incorrect <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 />OW0017196 <br />SINGH, HARWINDER <br />2958 HARDEMAN ST <br />HAYWARD, CA 94541 <br />510-305-6211 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0017771 <br />Facility name <br />MOUNTAIN MIKES PIZZA <br />Site address <br />229 E LOUISE AVE <br />City <br />LATHROP <br />ZIP code <br />95330 <br />Facility phone <br />209-858-1444 <br />Facility mailing address <br />229 E LOUISE AVE BOX 8 <br />2958 hardeman st <br />LATHROP, CA 953308631 <br />BILLING INFORMATION <br />114, 115, 116 <br />Contact name <br />MOUNTAIN MIKES PIZZA <br />Address <br />229 E LOUISE AVE BOX 8 <br />5103294806 <br />LATHROP, CA 953308631 <br />Contact phone <br />510-582-2219 <br />Contact email <br />Mail invoices to <br />Facility <br />Information after CIW processing CERS <br />(current submittal) field <br />harwindersingh <br />111 <br />2958 hardeman st <br />113 <br />hayward, CA 94541 <br />114, 115, 116 <br />5103294806 <br />112 <br />moValn mikes pizza 3 <br />229Touise Ave 103 <br />Lathrop 104 <br />95330 105 <br />2098581444 102 <br />229 a louise ave <br />108a <br />lathrop, CA 95330 <br />108b, 108c, 108d <br />harr�jjonder singh <br />140 <br />229 -Louise Ave <br />143 <br />Lathrop, CA 95330 <br />144, 145, 146 <br />5103294806 <br />141 <br />sppizzainc@hotmail.com <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:V Date: 5�-1-7 <br />Accounting: Reviewed by: Jb Date: `�/ 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 />1626 - RESTAURANT/BAR 101 + SEATS PR0526254 MELISSA NISSIM Active I ] I ] <br />1919 - HMBP-0O2 Only Food Facility i chem units PR0541786 MELISSA NISSIM Active I ] I ] <br />