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SAN JOAQU , OUNTY ENVIRONMENTAL HEALT EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/15/2015 <br /> Submitted on: 1/1/2015 1:34:44PM CERS ID: 10419718 <br /> Submitted by: Amritpal Tiwana Email: tiwanasubs@gmail.com Facility ID in CERS: FA0002361 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0003612 <br /> Owner name TIWANA, AMRITPAL S Amritpal Tiwana 111 <br /> Mailing address 4663 PACIFIC AVE STE B 5500 QUASHNICK RD 113 <br /> STOCKTON, CA 95207 STOCKTON, CA 95212 114, 115, 116 <br /> Work phone 209-482-2580 209 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002361 <br /> Facility name Subway#15879 Subway#15879 3 <br /> Site address 4410 E WATERLOO RD 4410 E Waterloo Rd Highway 88 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95215 95215 105 <br /> Facility phone 209-482-2580 209-482-2580 102 <br /> Facility mailing address 5500 QUASHNICK RD 5500 QUASHNICK RD 108a <br /> STOCKTON, CA 95212 STOCKTON. CA 95212 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name Subway 15879 Subway 15879 140 <br /> Address 5500 QUASHNICK RD 5500 QUASHNICK RD 143 <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 144, 145, 146 <br /> Contact phone 209-931-9557 209-931-9557 141 <br /> Contact email tiwagasubs@gmail.com tiwanasubs@gmail.com 142 <br /> Mail invoices to Facliity 6 <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG 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:_ AA Date: <br /> --------------- <br /> Accountin Reviewed by: Date: 3 S 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 /> 1624-RESTAURANT/BAR 21-50 SEATS PRO161740 LEYNA HUYNH Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO538674 JAMIE DE LA ROSA Active [ ] [ ] <br /> 3116-STORMWATER INSPECTION-FOOD PRO523051 VIDAL PEDRAZA Inactive [ ] [ ] <br />