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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/20/2017 <br />Submitted on: 1/16/2017 3:39:23PM <br />Submitted by: Bill Schaefer Email: debbie@hotcakesinc.org <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 : 2 <br />OW0015367 <br />Bill & ebbie Schaefer <br />642 W CHARTER WAY <br />STOCKTON, CA 95206 <br />559-313-5388 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0003041 <br />Facility name <br />Denny's # 7935 <br />Site address <br />3718 N Tracy Blvd <br />City <br />Tracy <br />ZIP code <br />95304 <br />Facility phone <br />559-313-5388 <br />Facility mailing address <br />3718 N. Tracy Blvd <br />Tracy, CA 95304 <br />BILLING INFORMATION <br />Contact name <br />Bill Schaefer <br />Address <br />596 Innocent Way <br />Copperopolis, CA 95228 <br />Contact phone <br />559-313-5388 <br />Contact email <br />bill@hotcakesinc.org <br />Mail invoices to <br />Account <br />CERS ID: 10711978 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Bill Schaefer 111 <br />596 Innocent Way 113 <br />Copperopolis, CA 95228 114, 115, 116 <br />559-313-5388 112 <br />Denny's # 7935 <br />3 <br />3718 N Tracy Blvd <br />103 <br />Tracy <br />104 <br />95304 <br />105 <br />559-313-5388 <br />102 <br />3718 N. Tracy Blvd 108a <br />Tracy, CA 95304 108b, 108c, 108d <br />Bill Schaefer 140 <br />596 Innocent Way 143 <br />Copperopolis, CA 95228 144, 145, 146 <br />559-313-5388 141 <br />bill@hotcakesinc.org 142 <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 />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: L Date: 1120+11 <br />--------------------------------- <br />Accounting: Reviewed by: Date: I /,;�v/1 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 PRO161134 MELISSA NISSIM Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0541381 MELISSA NISSIM Active [ ] [ ] <br />2066 - MILK DISPENSER PR0500161 NICHOLAS WIESEMAN Inactive [ ] [ ] <br />