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SAN JOAQUI*wOUNTY ENVIRONMENTAL HEALTH b=,OARTMENT . <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/112015 <br /> Submitted on: 11/30/2015 12:10:47PM 6ERS ID: 10448341 <br /> Submitted by: Jesse Diaz Email:jesse.diaz@loves.com Facility Ip in CERS: FA0021886 <br /> Information prior to CIW processing Information after CIW pr cess]ng CERS <br /> OWNER INFORMATION (current EC database) (current submitt�) field <br /> Number of Facilities for this Owner: 2 <br /> Owner ID OW0009856 <br /> Owner name LOVES COUNTRY STORES OF CA Love's Travel Stops and Country Stores 111 <br /> Mailing address PO BOX 26210 PO BOX 26210 113 <br /> OKLAHOMA CITY, OK 73126 Oklahoma City, OK 73126 114, 115, 116 <br /> Work phone 405-302-6638 (405) 242-2455 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021886 <br /> Facility name Love's Travel Stop#538 Love's Travel Stop#538 3 <br /> Site address 15250 N THORNTON RD 15250 North Thornton Road 103 <br /> City Lodi Lodi 104 <br /> ZIP code 95242 95242 105 <br /> Facility phone 405-687-1060 (405)687-1060 102 <br /> Facility mailing address PO Box 26210 PO Box 26210 108a <br /> Oklahoma City, OK 73126 Oklahoma City, OK 73126 i 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name Love's Country Stores of CA Love's Country Stores of CA I 140 <br /> Address PO Box 26210 PO Box 26210 143 <br /> Oklahoma City, OK 73126 Oklahoma City, OK 73126 <br /> 144,145, 146 <br /> Contact phone 405-302-6638 (405) 302-6638 141 <br /> Contact email jesse.diaz@]oves.com jesse.diaz@loves.com j 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ exempt from billing <br /> Processed through CERS Integration Wizard by: l �_Date: <br /> 't ]� <br /> -------L— ---- <br /> Accounting: Reviewed by: Lb Date: 12V/ Clerical: [ ] File [ ] Relabel fle [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: j Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW I <br /> Program Element and Description Record ID Employee name Status Deactivated Inactivated <br /> 1625-RESTAURANT/BAR 51-100 SEATS PR0540031 STEPHANIE RAMIREZ Active [ I [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO539990 JAMIE DE LA ROSA Active <br /> 2220-SM HW GEN<5 TONS/YR PRO539989 ARIS VELOSO Active [ ] [ ] <br /> 2351 -UST FACILITY-2481 COMPLIANT PRO537919 ARIS VELOSO Active [ ] [ ] <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PRO539991 not assigned Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO538168 ALFONSO ARAMBULA Active ( [ ] [ ] <br /> II <br /> I <br />