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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/5/2016 <br />Submitted on: 12/31/2015 9:17:13AM <br />Submitted by: Elaine McCampbell Email: emccampbell@foodmps.com <br />CERS ID: 10180693 <br />Facility ID in CERS: FA0001056 <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION (current EC database) —,l <br />(current submittal) <br />field <br />Number of Facilities for this Owner : 2 <br />PR0520721 <br />HAZA SAEED <br />Owner ID OW0000821 % <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PR0511174 <br />Owner name Buffets, Inc. <br />Buffets, Inc. <br />111 <br />Mailing address 1020 DISCOVERY RD STE 100 <br />120 Chula Vista <br />113 <br />EAGAN, MN 55121 <br />Hollywood Park, TX 78232 <br />114, 115, 116 <br />Work phone 651-994-8608 <br />(651) 994-8608 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID FA0001056 <br />Facility name HOMETOWN BUFFET #707 <br />HOMETOWN BUFFET #707 <br />3 <br />Site address 1025 W ROBINHOOD DR <br />1025 W ROBINHOOD DR <br />103 <br />City STOCKTON <br />STOCKTON <br />104 <br />ZIP code 95207 <br />95207 <br />105 <br />Facility phone 209-952-6688 <br />(209) 952-6688 <br />102 <br />Facility mailing address 1025 West Robinhood Drive <br />1025 West Robinhood Drive <br />108a <br />Stockton, CA 95207 <br />Stockton, CA 95207 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name Molly Peters <br />Elaine McCampbell <br />140 <br />Address 1020 Discovery Road, Suite 100 <br />120 Chula Vista <br />143 <br />Eagan, MN 55121 <br />Hollywood Park, TX 78232 <br />144, 145, 146 <br />Contact phone 651-365-2220 <br />210-403-3725 <br />141 <br />Contact email molly.peters@ovationbrands.com <br />emccampbell@foodmps.com <br />142 <br />Mail invoices to Account <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ <br />] RCRA HW New PR#: <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ <br />] UST New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year <br />[ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: `> Date: <br />1 f, <br />Accounting: Reviewed by: 16 Date: )' WIG, Clerical: <br />[ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified <br />By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1626 - RESTAURANT/BAR 101 + SEATS <br />PRO163381 <br />VIDAL PEDRAZA <br />Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location <br />PR0520721 <br />HAZA SAEED <br />Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />PR0511174 <br />HAZ MAT SJC OES <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0532356 <br />not assigned <br />Inactive [ ] [ ] <br />