Laserfiche WebLink
SAN JOAQW.- JOUNTY ENVIRONMENTAL HEALTF. _EPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/13/2015 <br />Submitted on: 12/30/2014 4:18:24PM CERS ID: 10187263 <br />Submitted by: anay reyes Email: areyes@encore. bz Facility ID in CERS: FA0019493 <br />OWNER INFORMATION <br />Owner I D <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />OW0016864 <br />ENCORE FGBF LLC <br />5005 LBJ FREEWAY STE 1200 <br />DALLAS, TX 75244 <br />209-473-9922 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0019493 <br />Facility name <br />FIVE GUYS <br />Site address <br />5633 PACIFIC AVE <br />City <br />STOCKTON <br />ZIP code <br />95207 <br />Facility phone <br />209-473-9922 <br />Facility mailing address 5005 LBJ FREEWAY STE 1200 <br />Information after CIW processing <br />(current submittal) <br />STOCKTON FG LLC <br />5005 LBJ Freeway Suite 1200 <br />Dallas, TX 75244 <br />209-473-9922 <br />FIVE GUYS <br />5633 PACIFIC AVE <br />STOCKTON <br />95207 <br />(209) 473-9922 <br />5633 Pacific Ave. <br />Stockton, CA 95207 <br />FIVE GUYS <br />/ 5633 PACIFIC AVE <br />✓ STOCKTON, CA 95207 <br />209-473-9922 <br />fg 1172@encore. bz <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 />CERS <br />field <br />111 <br />113 <br />114, 115, 116 <br />112 <br />3 <br />103 <br />104 <br />105 <br />102 <br />108a <br />108b, 108c, 108d <br />140 <br />143 <br />144, 145, 146 <br />141 <br />142 <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] <br />DALLAS, TX 75244 <br />BILLING INFORMATION <br />l�j�l rj <br />Contact name <br />FIVE GUYS <br />Address <br />5005 LBJ FREEWAY STE 1200 <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />DALLAS, TX 75244 <br />Contact phone <br />Contact email <br />Not Specified <br />Active [ ] [ ] <br />P, <br />Mail invoices to <br />y <br />Information after CIW processing <br />(current submittal) <br />STOCKTON FG LLC <br />5005 LBJ Freeway Suite 1200 <br />Dallas, TX 75244 <br />209-473-9922 <br />FIVE GUYS <br />5633 PACIFIC AVE <br />STOCKTON <br />95207 <br />(209) 473-9922 <br />5633 Pacific Ave. <br />Stockton, CA 95207 <br />FIVE GUYS <br />/ 5633 PACIFIC AVE <br />✓ STOCKTON, CA 95207 <br />209-473-9922 <br />fg 1172@encore. bz <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 />CERS <br />field <br />111 <br />113 <br />114, 115, 116 <br />112 <br />3 <br />103 <br />104 <br />105 <br />102 <br />108a <br />108b, 108c, 108d <br />140 <br />143 <br />144, 145, 146 <br />141 <br />142 <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] <br />next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: UA Date: .11- <br />l�j�l rj <br />Accounting: Reviewed by: Date: 3 (� Clerical: <br />X File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified <br />---------------------------------------------------------- <br />By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name <br />Status Reactivated Inactivated <br />1626 - RESTAURANT/BAR 101 + SEATS PR0529246 VIDAL PEDRAZA <br />Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location PR0535952 HAZA SAEED <br />Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0535977 not assigned <br />Inactive [ ] [ ] <br />