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AWL M9111116 <br /> SAN JOAQUI OUNTY ENVIRONMENTAL HEALTH PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 8/15/2014 <br /> Submitted on: 8/15/2014 9:30:07AM CERS ID: 10473613 <br /> Submitted by: gilbert Silva Email: gsilva@paginc.com Facility ID in CERS: FA0000473 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001562 <br /> Owner name PAQ Inc. PAQ Inc. DBA Rancho San Miguel 111 <br /> Mailing address gsilva@paqinc.com 17935 Murphy Parkway 113 <br /> Lathrop, CA 95330 Lathrop, CA 95330 114, 115, 116 <br /> Work phone 209-858-0101 209 858-0101 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000473 <br /> Facility name RANCHO SAN MIGUEL MARKETS PAQ Inc DBA Rancho San Miguel Market 3 <br /> Site address 620 S CHEROKEE LN 620 S Cherokee Ln 103 <br /> City LODI Lodi 104 <br /> Zip code 95240 95240 105 <br /> Facility phone 209-367-9900 209367-9900 102 <br /> Facility mailing address 8014 LOWER SACRAMENTO RD STE#1 17935 Murphy Parkway 108a <br /> STOCKTON, CA 95210 Lathrop, CA 95330 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name RANCHO SAN MIGUEL MARKETS Gilbert Silva 140 <br /> Address 8014 LOWER SACRAMENTO RD STE#1 17935 Murphy Parkway 143 <br /> STOCKTON, CA 95210 Lathrop, CA 95330 144, 145, 146 <br /> Contact phone 209-367-9900 209 858 0101 141 <br /> Contact email gsilva@paqinc.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP SQG HW [ ] LQG HW [ ] RCRA HW New PR#: P9-05_Wt13 <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 2111-0 <br /> Assigned to: VC�k-OSV <br /> Please bill: [ ] full calendar year 'N prorate this-ca1lendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: �N��� Date: <br /> Accounting: Reviewed by: _Date: 14 I"1 Clerical: File [ ] Relabel file (/Create new file <br /> ,A5&T71 [*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 /> 1619-RETAIL MKT>1000 SQ FT(=/>2 DEPTS) PRO161809 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 2066-MILK DISPENSER PR0200242 WILLIAM MARCHESE Inactive [ ] [ ] <br />