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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/27/2015 <br /> Submitted on: 4/17/2015 9:55:17AM CERS ID: 10448341 <br /> Submitted by: Jesse Diaz Email:jesse.diaz@loves.com Facility ID in CERS: FA0021886 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <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 108b,1080,load <br /> BILLING INFORMATION <br /> Contact name Love's Country Stores of CA Love's Country Stores of CA 140 <br /> Address PO Box 26210 PO Box 26210 143 <br /> Oklahoma City, OK 73126 Oklahoma City, OK 73126 144, 145, 146 <br /> Contact phone 405-302-6638 (405) 302-6638 141 <br /> Contact email jesse.diaz@loves.com jesse.diaz@loves.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ j 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: XA Date: 1`) <br /> - - -- ------ ---/— --- --- --- <br /> Accounting: Reviewed by: I,� Date: 61GII S 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 /> 1625-RESTAURANT/BAR 51-100 SEATS PRO540031 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO539990 JAMIE DE LA ROSA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0539989 ARIS VELOSO Active [ ] [ ] <br /> 2351 -UST FACILITY-2481 COMPLIANT PR0537919 ARIS VELOSO Active [ ] [ ] <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PR0539991 not assigned Active [ ] [ ] <br /> 4740-WASTE TIRE SITE-EXEMPT PRO538168 ALFONSO ARAMBULA Inactive [ ] [ ] <br />