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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 8/19/2015 <br />Submitted on: 8/12/2015 6:11:01 PM <br />Submitted by: Peter Liivoja Email: peter.Iiivoja@realmexrestaurants.com <br />CERS ID: 10180847 <br />Facility ID in CERS: FA0002000 <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Owner ID <br />OW0001568 <br />City <br />STOCKTON <br />Owner name <br />RM EL TORITO LLC <br />RM EL TORITO LLC <br />111 <br />Mailing address <br />5660 KATELLAAVE #200 <br />5660 KATELLAAVE #200 <br />113 <br />(209) 957-6891 <br />CYPRESS, CA 90630-5058 <br />CYPRESS, CA 90630-5058 <br />114, 115, 116 <br />Work phone <br />209-957-6891 <br />5623461200 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0002000 <br />Facility name <br />EL TORITO RESTAURANT <br />EL TORITO RESTAURANT <br />3 <br />Site address <br />2593 W MARCH LN <br />2593 W MARCH LN <br />103 <br />City <br />STOCKTON <br />STOCKTON <br />104 <br />ZIP code <br />95209 <br />95209 <br />105 <br />Facility phone <br />209-957-6891 <br />(209) 957-6891 <br />102 <br />Facility mailing address <br />PO BOX 780630 <br />5660 KATELLA AVE #200 <br />108a <br />WICHITA, KS 67278 <br />CYPRESS, CA 90630-5058 <br />108b,108c,108d <br />BILLING INFORMATION <br />Contact name <br />Address <br />Contact phone <br />Contact email <br />Mail invoices to <br />RM EL TORITO LLC <br />PO BOX 780630 <br />WICHITA, KS 67278 <br />562-346-1278 <br />Account <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 [ ] CalARP [ ] UST New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />1 ' �I <br />Processed through CERS Integration Wizard by: W " Date: <br />Accounting: Reviewed by: � Date: ! 10 /5 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 />1626 - RESTAURANT/BAR 101 + SEATS PRO160144 VIDAL PEDRAZA Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location PRO520728 HAZA SAEED Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511182 HAZ MAT SJC OES Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0532239 not assigned Inactive [ ] [ ] <br />