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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run' 2/19/2016 <br />Submitted on: 2/9/2016 11:23:49AM CERS ID: 10180795 <br />Submitted by: David Shoaff Email: dshoaff@redlobster.com Facility ID in CERS: FA0001655 <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 />OW0020200 <br />RED LOBSTER HOSPITALITY LLC <br />PO BOX 6508 <br />ORLANDO, FL 32802-6508 <br />855-530-1101 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0001655 <br />Facility name <br />RED LOBSTER RESTAURANT #381 <br />Site address <br />2283 W MARCH LN <br />City <br />STOCKTON <br />ZIP code <br />95207 <br />Facility phone <br />209-473-2420 <br />Facility mailing address <br />PO BOX 6508 <br />ORLANDO, FL 32802-6508 <br />BILLING INFORMATION <br />Contact name <br />RED LOBSTER HOSPITALITY LLC <br />Address <br />PO BOX 6508 <br />ORLANDO, FL 32802-6508 <br />Contact phone <br />855-530-1101 <br />Contact email <br />rhayward@darden.com <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />Red Lobster Hospitality LLC Attn: Risk 111 <br />PO BOX 4969 113 <br />ORLANDO, FL 32802 114, 115, 116 <br />407-734-9000 112 <br />RED LOBSTER RESTAURANT #381 3 <br />2283 W MARCH LN 103 <br />STOCKTON 104 <br />95207 105 <br />(209) 473-2420 102 <br />Po Box 4969 108a <br />ORLANDO, FL 32802 108b, 108c, 108d <br />Red Lobster Licensing Department 140 <br />PO BOX 4969 143 <br />ORLANDO, FL 32802 144, 145, 146 <br />407-734-9000 141 <br />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, thiscalendaryear [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by. Date: l Cl <br />Accounting: Reviewed by: Date: �l DLII, lP 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 />1626 - RESTAURANT/BAR 101 + SEATS PRO 160163 VIDAL PEDRAZA Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location PRO520764 HAZA SAEED Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO511229 HAZ MAT SJC OES Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PRO534668 not assigned Inactive [ l [ l <br />