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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 6/9/2017 <br />Submitted on: 6/8/2017 3:21:27PM <br />Submitted by: Harry Yu Email: mikasa138@yahoo.com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner <br />-AdVB9t596@ <br />YU, HARRY G <br />15971 ROCKY HARBOR RD <br />LATHROP, CA 953308791 <br />209-830-8288 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0021710 <br />Facility name <br />MIKASAASIAN BISTRO & SUSHI BAR <br />Site address <br />2610 S TRACY BLVD STE 110 <br />City <br />TRACY <br />ZIP code <br />95376 <br />Facility phone <br />209-830-8288 <br />Facility mailing address <br />2610 S TRACY BLVD STE 110 <br />(current submittal) <br />TRACY, CA 95376 <br />BILLING INFORMATION <br />104 <br />Contact name <br />MIKASAASIAN BISTRO & SUSHI BAR <br />Address <br />2610 S TRACY BLVD STE 110 <br />Tracy, CA 95376 <br />TRACY, CA 95376 <br />Contact phone <br />Not Specified <br />Contact email <br />Mail invoices to <br />Facility <br />CERS ID: 10737556 <br />Facility ID in CERS: incorrect <br />Information after CIW processing <br />CERS <br />(current submittal) <br />field <br />Tracy <br />104 <br />Mikasa Asian Bistro & Sushi Bar <br />111 <br />2610 S.Tracy Blvd, Ste 110 <br />113 <br />Tracy, CA 95376 <br />114, 115, 116 <br />(209)830-8288 <br />112 <br />MIKASAASIAN BISTRO & SUSHI BAR <br />3 <br />2610 S Tracy Blvd Ste 110 <br />103 <br />Tracy <br />104 <br />95376 <br />105 <br />(209) 830-8288 <br />102 <br />2610 S.Tracy Blvd, Ste 110 <br />108a <br />Tracy, CA 95376 <br />10eb, 10ec, toed <br />Harry Yu 140 <br />2610 S Tracy Blvd Ste 110 143 <br />Tracy, CA 95376 144, 145, 146 <br />(209)830-8288 141 <br />mikasa138@yahoo.com 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />New PE: _ <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ j exempt from billing <br />Processed through CERS Integration Wizard by: 00.1 Date: 6_q _1--7 <br />--------------- <br />Accounting: Reviewed by: Date: IZt % I Clerical: []File 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 PR0537684 MELISSA NISSIM Active [ ] [ ] <br />1919 - HMBP-CO2 Only Food Facility 1 chem units PR0541923 MELISSA NISSIM Active [ ] [ ] <br />S01 -i o'-Aer =0 as Pj- Owv,er recVK(% i, CL -W, fie 4 '-Jo <br />Je4 CCVA„c 5 W . 0~\ Aa_ <br />