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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 7/27/2018 <br />Submitted on: 3/13/2018 5:17:56PM <br />Submitted by: Hanna MacBurnie Email: hmac@casinostockton.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 />OW0001871 <br />DELTA RE LLC & DELTA CLP <br />240 N KENTER AVE <br />LOS ANGELES, CA 90049 <br />209-948-1100 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0002446 <br />Facility name <br />DELTA CASINO BAR RESTAURANT <br />Site address <br />6518 PACIFIC AVE <br />City <br />STOCKTON <br />ZIP code <br />95207 <br />Facility phone <br />209-948-1100 <br />Facility mailing address 6518 PACIFIC AVE <br />STOCKTON, CA 95207 <br />BILLING INFORMATION <br />Contact name DELTA CASINO BAR RESTAURANT <br />Address PO BOX 8070 <br />STOCKTON, CA 95208-0070 <br />Contact phone 209-817-1025 <br />Contact email <br />Mail invoices to Account <br />CERS ID: 10180931 <br />Facility ID in CERS: FA0002446 <br />Information after CIW processing CERS <br />(current submittal) field <br />DELTA RE LLC & DELTA CLP 111 <br />1014 NINTH ST 113 <br />SANTA MONICA, CA 90403 114, 115, 116 <br />2092674567 112 <br />DELTA CASINO BAR RESTAURANT <br />3 <br />6518 PACIFIC AVE <br />103 <br />STOCKTON <br />104 <br />95207 <br />105 <br />(209)948-1100 <br />102 <br />6518 PACIFICAVE 108a <br />STOCKTON, CA 95207 108b, 108c, 108d <br />DELTA CASINO BAR RESTAURANT 140 <br />6518 PACIFIC AVE 143 <br />STOCKTON, CA 95207 144, 145, 146 <br />2099566900 141 <br />142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST <br />New PR#: <br />New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar yearnext calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: IJ�✓� X—/ <br />Date: ~ -27 kj' <br />Accounting: Reviewed by: L45— Date: 711 g Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />filled By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1621 - BAR w/o FOOD PREP PRO160813 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0536817 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0536848 not assigned Inactive [ ] [ ] <br />