Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 8/16/2018 <br />Submitted on: 6/7/2018 12:15:19PM <br />Submitted by: susan Thao Email: sthao21@yahoo.com <br />CERS ID: 10629406 <br />Facility ID in CERS: FA0002344 <br />Employee name <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 />6200 Pacific Ave <br />Number of Facilities for this Owner : 2 <br />City <br />Stockton <br />Owner ID <br />OW0021265 <br />ZIP code <br />95207 <br />Owner name <br />Anil Yadav <br />Anil Yadav <br />111 <br />Mailing address <br />3550 Mowry Ave suite #301 <br />3550 Mowry Ave #301 <br />113 <br />6200 Pacific Ave <br />Fremont, CA 94538 <br />Fremont, CA 94538 <br />114, 115, 116 <br />Work phone <br />510-792-3393 <br />(530)792-3393 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0002344 <br />Employee name <br />Status Reactivated Inactivated <br />Facility name <br />JACK IN THE BOX #460 <br />JACK IN THE BOX #460 <br />3 <br />Site address <br />6200 Pacific Ave <br />6200 Pacific Ave <br />103 <br />City <br />Stockton <br />Stockton <br />104 <br />ZIP code <br />95207 <br />95207 <br />105 <br />Facility phone <br />209-406-8242 <br />(209)957-8173 <br />102 <br />Facility mailing address <br />3550 Mowry Ave suite #301 <br />6200 Pacific Ave <br />108a <br />Fremont, CA 94538 <br />Stockton, CA 95207 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name <br />Yadaz Inc <br />Anil Yadav <br />140 <br />Address <br />3550 Mowry Ave suite #301 <br />3550 Mowry Ave #301 <br />143 <br />Fremont, CA 94538 <br />Fremont, CA 94538 <br />144, 145, 146 <br />Contact phone <br />Not Specified <br />(530)792-3393 <br />141 <br />Contact email <br />142 <br />Mail invoices to <br />Account <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST <br />New PR#: <br />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: a Date: <br />Accounting: Reviewed by: Date: 4JI �I1 Clerical: [ ]File [ ]Relabel file [ ]Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1623 - RESTAURANT/BAR 1-20 SEATS <br />PRO160716 <br />MARIBEL FLOHRSCHUTZ <br />Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units <br />PR0520852 <br />MARIBEL FLOHRSCHUTZ <br />Active [ ] [ ] <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0515837 <br />HAZ MAT SJC OES <br />Inactive [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PR0515838 <br />RAYMOND BORGES <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0534150 <br />not assigned <br />Inactive [ ] [ ] <br />