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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 3/28/2017 <br />Submitted on: 2/21/2017 4:16:26PM <br />Submitted by: Erica Hartfield Email: 03664@chick-fil-a.com <br />CERS ID: 10725649 <br />Facility ID in CERS: incorrect <br />Facility name CHICK-FIL-A MARCH LN AT 15 Chick-fil-A March Lane at 1-5 <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Facility phone 209-477-5936 209-477-5936 <br />Number of Facilities for this r <br />Facility mailing address 2628 W MARCH LN 2628 W March Lane <br />108a <br />Owner ID <br />OW0001577 <br />BILLING INFORMATION <br />Owner name <br />THE EGG CAME FI ST LLC <br />Fica itartfletd <br />111 <br />Mailing address <br />2628 W MARCH LN <br />2628 W March Lane <br />113 <br />Contact email 03664@chick-fil-a.com <br />STOCKTON, CA 95207 <br />Stockton, CA 95207 <br />114, 115, 116 <br />Work phone <br />404-314-9688 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID FA0002011 <br />Facility name CHICK-FIL-A MARCH LN AT 15 Chick-fil-A March Lane at 1-5 <br />3 <br />Site address 2628 W MARCH LN 2628 W March Ln <br />103 <br />City STOCKTON Stockton <br />104 <br />ZIP code 95207 95207 <br />105 <br />Facility phone 209-477-5936 209-477-5936 <br />102 <br />Facility mailing address 2628 W MARCH LN 2628 W March Lane <br />108a <br />STOCKTON, CA 95207 Stockton, CA 95207 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name CHICK-FIL-A MARCH LN AT 15 Erica Hayfield <br />140 <br />Address 2628 W MARCH LN 2628 W March Ln <br />143 <br />STOCKTON, CA 95207 Stockton, CA 95207 <br />144, 145, 146 <br />Contact phone Not Specified 209-477-5936 <br />141 <br />Contact email 03664@chick-fil-a.com <br />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 this calendar year [ ] next calendar year [ <br />] exempt from billing <br />Processed through CERS Integration Wizard by:Date: <br />Accounting: Reviewed by: Lf _ Date: « �l Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: <br />Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1626 - RESTAURANT/BAR 101 + SEATS PRO160499 MARIBEL FLOHRSCHUTZ Active <br />[ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PRO520686 MARIBEL FLOHRSCHUTZ Active <br />[ ] [ ] <br />2066 - MILK DISPENSER PR0200207 WILLIAM MARCHESE Inactive <br />[ ] [ ] <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513415 HAZ MAT SJC OES Inactive <br />[ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511127 HAZ MAT SJC OES Inactive <br />(] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0534474 not assigned Inactive <br />[ ] [ ] <br />