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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 8/20/2014 <br /> Submitted on: 8/19/2014 11:44:35AM CERS ID: 10402351 <br /> Submitted by: Ranjeet Singh Email: s.ranjeet@outlook.com Facility ID in CERS: FA0019437 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> (current EC database) (current submittal) field <br /> OWNER INFORMATION <br /> Owner ID OW0015928 RANJEET SINGH 111 <br /> Owner name RANJEET SINGH <br /> Mailing address 1340 W. COLONY ROAD 1340 W. COLONY ROAD 113 <br /> RIPON, CA 95366 RIPON, CA 95366 114,115,116 <br /> Work phone 209-579-4014 209-579-4014 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019437 <br /> Facility name ARCO AM/PM#83230 ARCO am/pm#83230 3 <br /> Site address 1340 W Colony Rd 1340 W Colony Rd 103 <br /> City Ripon Ripon 104 <br /> Zip code 95366 95366 105 <br /> Facility phone 209-599-7600 209-599-7600 102 <br /> Facility mailing address 1340 W. COLONY ROAD 1340 W.COLONY ROAD 108a <br /> RIPON, CA 95366 RIPON, CA 95366 1086,108c,108d <br /> BILLING INFORMATION <br /> Contact name ARCO AM/PM#83230RANJEET SINGH 140 <br /> Address 1340 W. COLONY ROAD 1340 W Colony Rd 143 <br /> RIPON, CA 95366 Ripon, CA 95366 144, 145, 146 <br /> Contact phone Not Specified 209-579-4014 141 <br /> Contact email S.RANJEET@OUTLOOK.COM S.RANJEET@OUTLOOK.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 [ ]rynext calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: SAA Date: b 0 l <br /> Accounting: Reviewed by:_ P19 Date: 7 D Clerical: Y(File [ ] Relabel file [ ] Create new file <br /> ] Ac ed [ ] Surc veriledBy:_____ Date_ <br /> __ ________ _ <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) PRO537455 LISA MEDINA Active [ ] [ ] <br /> 1623-RESTAURANT/BAR 1-20 SEATS PRO537945 MELISSA NISSIM Inactive [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0537601 MICHAEL PARISSI Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0537500 ELENAMANZO Active [ ] [ ] <br /> 2351 -UST FACILITY-2481 COMPLIANT PRO529124 ELENAMANZO Active [ ] [ ] <br />