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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/6/2017 <br /> Submitted on: 6/5/2017 3:18:40PM CERS ID: 10737214 <br /> Submitted by: Yiota Aliferis Email: yiotaaliferis@gmail.com Facility ID in CERS: incorrect <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner : 1 <br /> Owner ID OW0002011 <br /> Owner name ALIFERIS, YIOTA Ujs family restaurant break 111 <br /> Mailing address 700 VICTOR RD 7628 Pacific Ave 113 <br /> LODI, CA 95240 Stockton, CA 95207 114, 115, 116 <br /> Work phone 209-957-3081 (209) 957-2081 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002654 <br /> Facility name USS FAMILY RESTAURANT& BREAK UXS FAMILY RESTAURANT 3 <br /> Site address 7628 PACIFIC AVE 7628 Pacific Ave 103 <br /> City STOCKTON Stockton 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-957-3081 (209) 957-2081 102 <br /> Facility mailing address 7628 PACIFIC AVE 7628 Pacific Avenue 108a <br /> STOCKTON, CA 95207 Stockton, CA 95207 108b, 108c,toed <br /> BILLING INFORMATION <br /> Contact name USS FAMILY RESTAURANT& BREAK Yiota Aliferis 140 <br /> Address 7628 PACIFIC AVE 7628 Pacific Ave 143 <br /> STOCKTON, CA 95207 Stockton, CA 95207 144, 145, 146 <br /> Contact phone Not Specified (209) 329-4336 141 <br /> Contact email ujs4714@sbcglobal.net 142 <br /> Mail invoices to Facility <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: avtn bL Date: <br /> Accounting: Reviewed by: Date: wq[ 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 Employee name Status Reactivated Inactivated <br /> 1626-RESTAURANT/BAR 101 +SEATS PRO160862 MARIBELFLOHRSCHUTZ Active I [ ] <br /> 1919-HMBP-0O2 Only Food Facility 1 chem units PR0541564 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br /> 2066-MILK DISPENSER PR0200858 NICHOLAS WIESEMAN Inactive [ ] [ ] <br /> G •�.n�2 cod ()L..-Aer 04%� �clltr�� 4?(Ovel b Tek Ltv-tAeVO t a1✓` <br />