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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/27/2016 <br /> Submitted on: 6/25/2016 11:30:57AM CERS ID: 10180993 <br /> Submitted by: Amritpal Tiwana Email: tiwanasubs@gmail.com Facility ID in CERS: FA0002754 <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: 2 <br /> Owner ID OW0021255 <br /> Owner name Vin Tiwana Tiwana & Sons Inc 111 <br /> Mailing address 5500 Quashnick Rd 5500 Quashnick RD 113 <br /> Stockton, CA 95212 STOCKTON, CA 95212 114, 115, 116 <br /> Work phone 209-298-6629 209-298-6629 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002754 <br /> Facility name SUBWAY SANDWICHES &SALADS Tiwana & Sons Inc dba Subway# 1955 3 <br /> Site address 8046 WEST LN 8046 WEST LN 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95210 95210 105 <br /> Facility phone 209-473-1678 (209)473-1678 102 <br /> Facility mailing address 5500 Quashnick Rd 5500 Quashnick Rd 108a <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 108b,108c,load <br /> BILLING INFORMATION <br /> Contact name Subway# 1955 Vin Tiwana 140 <br /> Address 5500 Quashnick Rd 5500 Quashnick Rd 143 <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 144, 145, 146 <br /> Contact phone 209-473-1678 2094731678 141 <br /> Contact email tiwanasubs@gmail.com tiwanasubs@gmail.com 142 <br /> Mail invoices to Account <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 t is calendar year [ ] next calendar year ( ] exempt from billing <br /> Processed through CERS Integration <br /> ddWizard by: Date: yq4-11)w <br /> Accounting: Reviewed by: l4�;' Date: /W l to 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 PRO160782 JEFFREY WONG Active [ ] [ ] <br /> 1919-HMBP-0O2 Only Food Facility PRO530855 JEFFREY WONG Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534334 not assigned Inactive [ ] [ ] <br />