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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 117!2015 <br /> Submitted on: 1/3/2015 3:39:36PM CERS ID: 10184181 <br /> Submitted by: Ray Cuadros Email: tracy a@applebythebay,com Facility ID in CERS: FA0012293 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0009529 <br /> Owner name APPLE GILROY INC APPLE GILROY INC 111 <br /> Mailing address 999 W TAYLOR ST D 999 W TAYLOR ST D 113 <br /> SAN JOSE, CA 95126-1850 SAN JOSE, CA 95126-1850 114, 115, 11E <br /> Work phone 408-534-0800 1-408-534-0800 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012293 <br /> Facility name APPLEBEES NEIGHBORHOOD GRILL & B APPLEBEES NEIGHBORHOOD GRILL& B 3 <br /> Site address 3060 NAGLEE RD 3060 Naglee Rd 103 <br /> City TRACY 104 <br /> ZIP code 95376 95304 105 <br /> Facility phone 209-834-0360 (209) 834-0360 102 <br /> Facility mailing address 3060 NAGLEE RD Tracy 3060 NAGLEE RD 108a <br /> TRACY, CA 95376 TRACY, CA 95304 108b 1o8c, 10E <br /> BILLING INFORMATION <br /> Contact name APPLEBEES NEIGHBORHOOD GRILL & B APPLEBEES NEIGHBORHOOD GRILL& B 140 <br /> Address 3060 NAGLEE RD 3060 NAGLEE RD 143 <br /> TRACY, CA 95376 TRACY, CA 95304 144, 145, 14E <br /> Contact phone 209-834-0360 209-834-0360 141 <br /> Contact email 142 <br /> Mail invoices to Faei+ity <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 [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Arl ) Date: <br /> Accounting: Reviewed by: Date:�1 g/1 S Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ j Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1626-RESTAURANTIBAR 101 +SEATS PR0515698 MELISSA NISSIM Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0526520 MICHAEL PARISSI Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533524 not assigned Inactive [ ] [ <br />