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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />` Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 8/2/2018 <br />Submitted on: 5/10/2018 1:37:32PM <br />Submitted by: James Yorke Email: jryorke@yorkeengr.com <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 />OW0003555 <br />Trader Joe's Company <br />800 S. Shamrock Ave. <br />Monrovia, CA 91016 <br />626-599-3700 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0004664 <br />Facility name <br />Trader Joe's #76 <br />Site address <br />6535 Pacific Ave <br />City <br />Stockton <br />ZIP code <br />95207 <br />Facility phone <br />209-951-7597 <br />Facility mailing address 800 S. Shamrock Ave <br />CERS ID: 10740322 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Trader Joe's Company 111 <br />800 S. Shamrock Ave. 113 <br />Monrovia, CA 91016 114, 115, 116 <br />(626) 599-3700 112 <br />Trader Joe's #76 <br />Monrovia, CA 91016 <br />BILLING INFORMATION <br />103 <br />Contact name <br />Trader Joe's Company <br />Address <br />800 S. Shamrock Ave. <br />(209) 951-7597 <br />Monrovia, CA 91016 <br />Contact phone <br />626-599-3700 <br />Contact email <br />invoices@traderjoes.com <br />Mail invoices to <br />Account <br />CERS ID: 10740322 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Trader Joe's Company 111 <br />800 S. Shamrock Ave. 113 <br />Monrovia, CA 91016 114, 115, 116 <br />(626) 599-3700 112 <br />Trader Joe's #76 <br />3 <br />6535 Pacific Ave <br />103 <br />Stockton <br />104 <br />95207 <br />105 <br />(209) 951-7597 <br />102 <br />800 S. Shamrock Ave. <br />108a <br />Monrovia, CA 91016 <br />108b, 108c, 108d <br />Trader Joe's Company 140 <br />800 S. Shamrock Ave. 143 <br />Monrovia, CA 91016 144, 145, 146 <br />(626) 599-3700 141 <br />invoices@traderjoes.com 142 <br />Program record [ ] HMBP [ SQG HW [ ] LQG HW [ ] RCRA HW New PR#: '� Hit✓ <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br />Assigned to: I— WnL. C_ -U,, ; <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: �/ A Date:' - [� <br />---------------------------------------------------- <br />Accounting: Re .ewed by: Date: l E Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[✓Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />JW03100+j Record ID Employee name Status Reactivated Inactivated <br />1617 - RETAIL MARKET > 1000 SQ FT W / FOOD PREP PR0500169 VIDAL PEDRAZA Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location 2 chem units PR0543618 JAMIE LIMA Active [ ] [ ] <br />L(����ea �� ��, Rif Le 0'- S l��iN•� iV' r �'� <br />1' <br />