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SAN JOAQUIN tvUNTY ENVIRONMENTAL HEALTFWARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 6/25/2014 <br />Submitted on: 1/10/2014 2:51:33PM CERS ID: 10182149 <br />Submitted by: gilbert silva Email: gsilva@paqinc.com Facility ID in CERS: FA0006844 <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 />OW0001562 <br />PAQ INC <br />17935 MURPHY PARKWAY <br />LATHROP, CA 95330 <br />209-858-0101 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0006844 <br />Facility name <br />FOOD 4 LESS <br />Site address <br />2430 W KETTLEMAN LN <br />City <br />LODI <br />Zip code <br />95240 <br />Facility phone <br />209-366-1053 <br />Facility mailing address <br />8014 LOWER SACRAMENTO RD STE I <br />STOCKTON, CA 95210 <br />BILLING INFORMATION <br />Contact name FOOD 4 LESS <br />Address 8014 LOWER SACRAMENTO RD STE I <br />STOCKTON, CA 95210 <br />Contact phone 209-366-1053 <br />Contact email <br />Mail invoices to Facility <br />Information after CIW processing CERS <br />(current submittal) field <br />PAQ INC 111 <br />17935 MURPHY PARKWAY 113 <br />LATHROP, CA 95330 114, 115, 116 <br />(209) 366-1053 112 <br />FOOD 4 LESS 3 <br />2430 W KETTLEMAN LN 103 <br />LODI 104 <br />95240 105 <br />(209) 366-1053 102 <br />17935 Murphy Parkway 108a <br />Lathrop, CA 95330 108b, 108c, 108d <br />FOOD 4 LESS <br />140 <br />17935 Murphy Parkway <br />143 <br />Lathrop, CA 95330 <br />144, 145, 146 <br />(209) 858-0101 Ext 5 <br />141 <br />gsilva@paginc.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: Date: <br />Accounting: Reviewed by:_ Date: 'pial Clerical: k File [ ] Relabel file [ ] Create new file <br />[ ] Ac ed [ ] Surchar enfled l 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 />1619 - RETAIL MKT >1000 SQ FT (=/>2 DEPTS) PR0505538 NICHOLAS WIESEMAN Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location PR0531239 JAMIE DE LA ROSA Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE F PR0533947 not assigned Inactive [ ] [ ] <br />