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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 6/21/2017 <br />Submitted on: 6/21/2017 11:03:37AM <br />Submitted by: Barry Stirm Email: bstirm@comcast.net <br />CERS ID: 10724533 <br />Facility ID in CERS: incorrect <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 />Number of Facilities for this Owner : 4 <br />Owner ID <br />OW0005076 <br />Owner name <br />STIRM FAMILY INC <br />Barry Stirm <br />111 <br />Mailing address <br />1153 DEVINE DR <br />12352 E State rt 12 <br />113 <br />LODI, CA 95240 <br />Lockeford, CA 95237 <br />114, 115, 116 <br />Work phone <br />209-943-1431 <br />209-200-2323 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0007204 <br />Facility name <br />SUBWAY <br />Subway 18353 <br />3 <br />Site address <br />2434 W KETTLEMAN LN <br />2434 W Kettleman Ln # 18353 <br />103 <br />City <br />LODI <br />Lodi <br />104 <br />ZIP code <br />95242 <br />95242 <br />105 <br />Facility phone <br />209-368-4157 <br />209-200-2323 <br />102 <br />Facility mailing address <br />2434 W KETTLEMAN LN <br />2434 W Kettleman Ln <br />108a <br />LODI, CA 95242 <br />Lodi, CA 95242 <br />108b, 108c, 1084 <br />BILLING INFORMATION <br />Contact name <br />SUBWAY <br />Barry Stirm <br />140 <br />Address <br />2434 W KETTLEMAN LN <br />12352 E State rt 12 <br />143 <br />LODI, CA 95242 <br />Lockeford, CA 95237 <br />144, 145, 146 <br />Contact phone <br />209-368-4157 <br />209-200-2323 <br />141 <br />Contact email <br />Mail invoices to/ <br />F <br />bstirm@comcast.net <br />142 <br />Program record HMBP [ ] SQG HW [ ] LOG HW <br />[ ] RCRA HW New PR#: O 4)-00 <br />created [ ] Tiered <br />permit [ ] APSA [ ] CalARP <br />[ ] UST New PE: � 0�o <br />Assigned to: kr r— RZ <br />Please bill: [vKfull calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration `Wizard by: 00 `" Date: G ;- I <br />Accounting: Reviewed by: th Date: 4 24 1 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />Acct billed [ Ourcharge verified--------------------------- By:_ _ _ _ _ Date_ <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1623 - RESTAURANT/BAR 1-20 SEATS PR05061105 STEPHANIE RAMIREZ Active n- I I I I <br />(—(-. Ie- t9� owner o�l(Iwek m5 per —17o6,3 no(Ovl - 00M'(�Z' <br />�w-t agy853 <br />