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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 8/16/2016 <br /> Submitted on: 8/9/2016 12:47:51 PM CERS ID: 10687723 <br /> Submitted by: Istvan Deli Email: istvan@grimaudfarms.com Facility ID in CERS: incorrect <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0021856 <br /> Owner name DUPONT MARKET INC Howard Chan 111 <br /> Mailing address 1320-A S AURORA ST 1320-A S Aurora Street 113 <br /> STOCKTON, CA 95206 Stockton, CA 95206 114, 115, 116 <br /> Work phone 209-466-3200 xt 112 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0023565 <br /> Facility name DUPONT MARKET INC DBA GRIMAVO FAI Dupont Market, Inc. dba Grimaud Farms 3 <br /> Site address 1320-A S AURORA ST 1320 S Aurora St Ste A 103 <br /> City STOCKTON Stockton 104 <br /> ZIP code 95206 95206 105 <br /> Facility phone 209-466-3200 209-466-3200xt112 102 <br /> Facility mailing address 1320-A S AURORA ST 1320-A S Aurora Street 108a <br /> STOCKTON, CA 95206 Stockton, CA 95206 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name DUPONT MARKET INC DBA GRIMAVO FAI Howard Chan 140 <br /> Address 1320-A S AURORA ST 1320-A S Aurora Street 143 <br /> STOCKTON, CA 95206 Stockton, CA 95206 144, 145, 146 <br /> Contact phone Not Specified 209-466-3200 xt 112 141 <br /> Contact email howard@grimaudfarms.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP t�j SQG HW [ ] LQG HW [ ] RCRA HW New PRM (2- <br /> created <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: ZL2p <br /> I/y Assigned to: Afk.At-jT I <br /> Please bill: [ ] full calendar year-4 prorate thi __lalendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration)I Wizard by: JWv Date: D ' kb. ( b <br /> Accounting Re�sewed by: UJ Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> M Acct billed By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMP-Regular-Primary Location PR0541192 ROBERT LOPEZ Active 11 11 <br /> W c 2— . <br />