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Milk A& <br /> SAN JOAQUIN'OUNTY ENVIRONMENTAL HEALTH EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 717/2014 <br /> Submitted on: 3/10/2014 12:11:35PM CERS ID: 10180891 <br /> Submitted by: Alan Taylor Email: ataylor@pacificbowl.com Facility ID in CERS: FA0002230 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001728 <br /> Owner name Nakashima, Ren Nakashima, Ren 111 <br /> Mailing address 5939 PACIFIC AVE 5939 PACIFIC AVE 113 <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 114, 115, 116 <br /> Work phone 209-649-0369 (209) 649-0369 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002230 <br /> Facility name PACIFIC AVENUE LOUNGE PACIFIC AVENUE LOUNGE 3 <br /> Site address 5939 PACIFIC AVE 5939 PACIFIC AVE 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 95207 95207 105 <br /> Facility phone 209-477-0267 (209)477-0267 0 102 <br /> Facility mailing address 5939 PACIFIC AVE 5939 PACIFIC AVE 108a <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name PACIFIC AVENUE LOUNGE PACIFIC AVENUE LOUNGE 140 <br /> Address 5939 PACIFIC AVE 5939 PACIFIC AVE 143 <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 144, 145, 146 <br /> Contact phone 209-477-0267 (209)477-0267 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: Date: <br /> Accounting: Reviewed by: 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 /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1621 -BAR w/o FOOD PREP PRO160062 VIDAL PEDRAZA Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0520854 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO515836 JOHNNY YOAKUM Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PR0531697 not assigned Inactive [ ] [ ] <br />