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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/15/2015 <br /> Submitted on: 1/1412015 8:03:31AM CERS 1D: 10422145 <br /> Submitted by: Ken Ilejay Email: kilejay@savemart.com Facility ID in CERS FA0000449 <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 FA0000449 <br /> Facility name S-Mart#209 S-Mart#209 3 <br /> Site address 610 W Kettleman Ln 610 W Kettleman Ln 103 <br /> City Lodi Lodi 104 <br /> ZIP code 95240 95240 105 <br /> Facility phone 209-334-6853 209-334-6853 102 <br /> Facility mailing address PO Box 4664 9800 Standiford Ave. 108a <br /> Modesto, CA 95352 Modesto, CA 95350 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name S-Mart#209 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 Facriity k`:.1 <br /> 4 <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 calendarear <br /> y [ ] exempt from biding <br /> Processed through CERS Integration jWizard by: Date: -yl7 <br /> Accounting: Reviewed by: `y Date: 14 Clerical: [XI File [ ] Relabel file [ ] Create new file <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 ET(=1>2 DFPTS) PRO160214 NICHOLAS INIESEMAN Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO538671 JAMIE DF LA ROSA Active [ ] [ ] <br /> 2220_SM HW GEN<5 TONS/YR PR0538670 ARIS VELOSO Active ( ] ( ] <br />