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SAN JOAQUIOUNTY ENVIRONMENTAL HEALT EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 4/9/2015 <br /> Submitted on: 2/20/2015 11:07:47AM CERS ID: 10421809 <br /> Submitted by: Lisette Garcia Email: lisette.garcia@savemart.com Facility ID in CERS: FA0016538 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000369 <br /> Owner name Save Mart Supermarkets Save Mart Supermarkets 111 <br /> Mailing address 1800 Standiford Ave. 1800 Standiford Ave. 113 <br /> Modesto, CA 95350 Modesto, CA 95350 114,115, 116 <br /> Work phone 209-577-1600 209-577-1600 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016538 <br /> Facility name Save Mart#94 Save Mart#94 3 <br /> Site address 15240 S Harlan Rd 15240 S Harlan Rd 103 <br /> City Lathrop Lathrop 104 <br /> ZIP code 95330 95330 105 <br /> Facility phone 209-8584798 209-858-4798 102 <br /> Facility mailing address 1800 Standiford Ave. 1800 Standiford Ave. 108a <br /> Modesto, CA 95350 Modesto, CA 95350 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name ATTN: ACCOUNTING ATTN: ACCOUNTING 140 <br /> Address P.O. Box 4664 P.O. Box 4664 143 <br /> Modesto, CA 95352 Modesto, CA 95352 144, 145, 146 <br /> Contact phone 209-574-6292 209-574-6292 141 <br /> Contact email lorna@savemart.com lorna.reynolds@savemart.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year ( ] prorate <br /> �this <br /> Jcalendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: VA Date: Ll •LI' I <br /> -------------------------------------- <br /> // ------------ <br /> Accounting: Reviewed by: l�QQDate: 41�l/5 " Clerical: [File [ ] Relabel file [ ] Create newfile <br /> [ ] Acct billed [ ] Surcharge verified 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(=1>2 DEPTS) PR0524635 MELISSA NISSIM Active [ ] [ ] <br /> 921 -HMBP-Regular-Primary Location PRO539365 MICHAEL PARISSI Active [ ] [ ] <br /> 0 SM HW GEN<5 TONSNR PR0538347 THUY TRAN Active [ ] [ ] <br /> CH�MT�o N PeYL- CC-rLS Sv,&AA . srrl.. <br />