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SAN ,JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> __:7Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/19J2014 <br /> Submitted on: 6/3/2014 3:07:38PM CERS ID: 10180631 <br /> Submitted by: Roger Batra Email: roger.batra@quikstop.com <br /> Facility ID in CERS: FA0000591 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000478 <br /> Owner name QUIK STOP MARKETS INC QUIK STOP MARKETS INC 111 <br /> Mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 113 <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 114, 115, 116 <br /> Work phone 510-657-8500 510-657-8500 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000591 <br /> Facility name QUIK STOP MARKET#2152 QUIK STOP MARKET#2152 3 <br /> Site address 1721 S CHEROKEE LN 1 1721 S CHEROKEE LN 1 103 <br /> City Lodi LODI 104 <br /> Zip code 95240 95240 105 <br /> Facility phone 209-369-7375 (209) 369-7375 102 <br /> Facility mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 108a <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 108b, 108c, 108d <br /> BILLING INFORMATION <br /> Contact name QUIK STOP MARKET#2152 QUIK STOP MARKET#2152 140 <br /> Address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 143 <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 144, 145, 146 <br /> Contact phone 510-445-2285 510-445-2285 141 <br /> Contact email mike.karvelot@quikstop.com roger.batra@quikstop.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] 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: �^" Date: <br /> Accounting: Reviewed by: Date: Clerical: /[ File [ ] Relabel file [ ] Create new file <br /> A filled Sur a veri Ief d B <br /> [ ] � [ ] F v ri-- - y Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1617-RETAIL MARKET> 1000 SO FT VV 1 FOOD PREP PRO162484 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0519949 JAMIE DE LA ROSA Active [ ) [ ] <br /> 2220-SM HVV GEN<5 TONS/YR PR0518706 ARIS VFLOSO Active [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PR0508274 GARRETTBACKUS Inactive [ ] [ ] <br /> 2361 -UST FACILITY PR0232355 ARTS VELOSO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAG STATE SURCHARGE FEE PRO507254 GARRETTBACKUS Inactive [ ] [ ] <br />