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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 5/10/2017 <br />Submitted on: 5/4/2017 4:28:22PM CERS ID: 10180847 <br />Submitted by: Daniel Vasquez Email: daniel.vasquez@realmexrestaurants.com Facility ID in CERS: FA0002000 <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 />OW0001568 <br />RM EL TORITO LLC <br />PO BOX 780630 <br />WICHITA, KS 67278 <br />562-346-1200 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0002000 <br />Facility name <br />EL TORITO RESTAURANT <br />Site address <br />2593 W MARCH LN <br />City <br />STOCKTON <br />ZIP code <br />95209 <br />Facility phone <br />209-957-6891 <br />Facility mailing address <br />PO BOX 780630 <br />Record ID Employee name <br />WICHITA, KS 67278 <br />BILLING INFORMATION <br />Active [ ] [ ] <br />Contact name <br />RM EL TORITO, LLC <br />Address <br />PO BOX 780630 <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511182 HAZ MAT SJC OES <br />WICHITA, KS 67278 <br />Contact phone <br />316-685-1622 <br />Contact email <br />Peter.Liivoja@realmexrestaurants.com <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />RM EL TORITO LLC 111 <br />5660 KATELLA AVE #200 113 <br />CYPRESS, CA 90630-5058 114, 115, 116 <br />5623461200 112 <br />EL TORITO RESTAURANT 3 <br />2593 W MARCH LN 103 <br />STOCKTON 104 <br />95209 105 <br />(209) 957-6891 102 <br />5660 KATELLA AVE #200 108a <br />CYPRESS, CA 90630-5058 108b, 108c, 108d <br />EL TORITO RESTAURANT 140 <br />5660 KATELLA AVE #200 143 <br />CYPRESS, CA 90630-5058 144, 145, 146 <br />5623461200 141 <br />Peter.Liivoja@realmexrestaurants.com 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST <br />New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] <br />next calendar year [ J exempt from billing <br />V <br />Processed through CERS Integration Wizard by: im," Date: <br />Accounting: Reviewed by:�i1� Date: 5�/ 7I/7 Clerical: <br />[ ] File [ ] Relabel file [ ] Create new file <br />----------------------- <br />By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name <br />Status Reactivated Inactivated <br />1626 - RESTAURANT/BAR 101 + SEATS PRO160144 VIDAL PEDRAZA <br />Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0520728 VIDAL PEDRAZA <br />Active [ ] [ ] <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513470 HAZ MAT SJC OES <br />Inactive [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511182 HAZ MAT SJC OES <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0532239 not assigned <br />Inactive [ ] [ ] <br />