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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/11/2017 <br />Submitted on: 7/10/2017 3:53:49PM CERS ID: 10181295 <br />Submitted by: enayatullah noorulhuda Email: noorenaya@gmail.com Facility ID in CERS: FA0003677 <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: 1 <br />OW0017790 <br />OMAR, MUSHTAQ <br />824 E YOSEMITE AVE <br />MANTECA, CA 95336 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0003677 <br />Facility name <br />DIAMOND GAS & MART <br />Site address <br />824 E YOSEMITE AVE <br />City <br />MANTECA <br />ZIP code <br />95336 <br />Facility phone <br />209-823-8800 <br />Facility mailing address 824E YOSEMITE AVE <br />Information after CIW processing CERS <br />(current submittal) field <br />Quick Serve <br />MANTECA, CA 95336 <br />BILLING INFORMATION <br />113 <br />Contact name <br />DIAMOND GAS & MART <br />Address <br />824 E YOSEMITE AVE <br />Accounting: Reviewed by: th Date:?Ilyr, 1 Clerical: [ ] <br />MANTECA, CA 95336 <br />Contact phone <br />209-823-8800 <br />Contact email <br />Date: <br />------- <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />Quick Serve <br />111 <br />824 E YOSEMITE AVE <br />113 <br />MANTECA, CA 95336 <br />114, 115, 116 <br />2098238800 <br />112 <br />Diamond Gas and Mart DBA Quick Serve 3 <br />824 E YOSEMITE AVE <br />103 <br />MANTECA <br />104 <br />95336 <br />105 <br />2098238800 <br />102 <br />824 E YOSEMITE AVE 108a <br />MANTECA, CA 95336 108b, 1oac, load <br />quick Serve <br />140 <br />824 E YOSEMITE AVE <br />143 <br />MANTECA, CA 95336 <br />144, 145, 146 <br />2098238800 <br />141 <br />Accounting: Reviewed by: th Date:?Ilyr, 1 Clerical: [ ] <br />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 [ <br />] exempt from billing <br />-7-10-7 <br />OV <br />Processed through CERS Integration Wizard by: OA b` Date: <br />Accounting: Reviewed by: th Date:?Ilyr, 1 Clerical: [ ] <br />File [ ] Relabel <br />file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified <br />------------------------------- <br />By: <br />Date: <br />------- <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING <br />THROUGH CIW <br />Record ID Employee name <br />Status <br />Reactivated Inactivated <br />1617 -RETAIL MARKET> 1000 SO FT W / FOOD PREP PR0505505 KADEANNE LINHARES <br />Active <br />[ ] [ ] <br />1920 - HMBP-Common Materials 4 chem units PRO530799 NICHOLAS LOEHRER <br />Active <br />[ ] [ ] <br />2220 - SM HW GEN <5 TONS/YR PR0518762✓ JOHN ALANIZ <br />Active <br />[ J [ ] <br />2361 -UST FACILITY PR0231459✓ JOHNALANIZ <br />Active <br />[ ] [ ] <br />1921 - HMBP-Regular-Primary Location 1 chem units PRO522041 NICHOLAS LOEHRER <br />Inactive <br />[ ] [ ] <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512671 NICHOLAS LOEHRER <br />Inactive <br />[ ] [ ] <br />2301 - UST STATE SURCHARGE FEE PRO508292 ALISON YOUNGBLOOD <br />Inactive <br />[ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507395 ALISON YOUNGBLOOD <br />Inactive <br />[ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0532387 not assigned <br />Inactive <br />[ ] [ ] <br />G. C'Vle o4 t�� aj,'Jk/d n.S Per 3c 4- C& /r,,testo c4,L r `e/,(k tlLM7rJ: <br />