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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/11/2014 <br /> Submitted on: 2/25/2014 12:18:15PM CERS ID: 10421809 <br /> Submitted by: Beth Granger Email: egranger@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 209-858-4798 209-858-4798 102 <br /> Facility mailing address PO BOX 4664 1800 Standiford Ave. 108a <br /> Modesto, CA -95352 Modesto, CA 95350 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name Save Mart#94 ATTN: ACCOUNTING 140 <br /> Address PO BOX 4664 P.O. Box 4664 143 <br /> Modesto, CA 95352 Modesto, CA 95352 144, 145, 146 <br /> Contact phone Not Specified 209-574-6292 141 <br /> Contact email lorna savemart.com lorna@savemart.com 142 <br /> Mail invoices to Fa O w y ,/ )� ' <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 /> [ ] Acc ed [ ] Surchar e fled By: Date: <br /> ----------- <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) PR0524635 MELISSA NISSIM Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0538347✓ THUY TRAN Active [ ] [ l <br />