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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard Date run: 5/31/2017 <br />Submitted on: 5/24/2017 3:25:29PM CERS ID: 10685560 <br />Submitted by: parminder singh Email: handppizzainc@hotmail.com Facility ID in CERS: incorrect <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 />OW0006517 <br />SINGH, PARMINDER <br />728 W KETTLEMAN LN <br />LODI. CA 95242 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0007873 <br />Facility name <br />MOUNTAIN MIKE'S PIZZA <br />Site address <br />728 W KETTLEMAN LN <br />City <br />LODI <br />ZIP code <br />95242 <br />Facility phone <br />510-329-4806 <br />Facility mailing address 728 W KETTLEMAN LN <br />Information after CIW processing CERS <br />(current submittal) field <br />Parminder Singh 111 <br />728 W. Kettleman Lane 113 <br />Lodi, CA 95240 114, 115, 116 <br />5103294806 112 <br />Mountain Mike's Pizza <br />LODI, CA 95242 <br />BILLING INFORMATION <br />103 <br />Contact name <br />MOUNTAIN MIKE'S PIZZA <br />Address <br />728 W KETTLEMAN LN <br />2096258380 <br />LODI, CA 95242 <br />Contact phone <br />510-3294806 <br />Contact email <br />Mail invoices to <br />Facility <br />Information after CIW processing CERS <br />(current submittal) field <br />Parminder Singh 111 <br />728 W. Kettleman Lane 113 <br />Lodi, CA 95240 114, 115, 116 <br />5103294806 112 <br />Mountain Mike's Pizza <br />3 <br />728 W Kettleman Ln <br />103 <br />Lodi <br />104 <br />95240 <br />105 <br />2096258380 <br />102 <br />728 W. Kettleman Lane 108a <br />Lodi, CA 95240 108b, 1oac, 1o6d <br />Parminder Singh <br />140 <br />728 W. Kettleman Lane <br />143 <br />Lodi, CA 95240 <br />144, 145, 146 <br />5103294806 <br />141 <br />par—Singh0l@yahoo.com <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 [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Q~ Ca— Date: '�-- 51'VI <br />--------------- <br />Accounting: Reviewed by: � Dater u 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 />1625 - RESTAURANT/BAR 51-100 SEATS PR0507997 STEPHANIE RAMIREZ Active I ] I ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PRO541702 STEPHANIE RAMIREZ Active I ] I ] <br />