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SAN JOAQUI COUNTY ENVIRONMENTAL HEALTH EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 12/8/2015 <br /> Submitted on: 12/7/2015 2:04:12PM CERS ID: 10180609 <br /> Submitted by: Manu Trehan Email: manutrehan@hotmail.com Facility I D in CERS: FA0000511 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 1 <br /> Owner ID OW0000422 <br /> Owner name TREHAN, PROMOD K TREHAN, PROMOD K 111 <br /> Mailing address 10203 TANK HOUSE DR 10203 TANK HOUSE DR 113 <br /> STOCKTON, CA 95209 STOCKTON, CA 95209 114, 115,116 <br /> Work phone 209-334-3678 (209) 334-3678 112 <br /> FACILITY FILE INFORMATION <br /> I <br /> Facility ID FA0000511 <br /> Facility name AJSAM/PM MINI MARKET AJSAM/PM MINI MARKET 3 <br /> Site address 800 E KETTLEMAN LN 800 E KETTLEMAN LN 103 <br /> City LODI LODI 104 <br /> ZIP code 95240 95240 105 <br /> Facility phone 209-334-3678 (209)334-3678 102 <br /> Facility mailing address 800 E KETTLEMAN LN 800 E KETTLEMAN LN 108a <br /> LODI, CA 95240 LODI, CA 95240 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name AJSAM/PM MINI MARKET AJSAM/PM MINI MARKET 140 <br /> Address 800 E KETTLEMAN LN 800 E KETTLEMAN LN 143 <br /> LODI, CA 95240 LODI, CA 95240 144, 145, 146 <br /> Contact phone 209-334-3678 (209) 334-3678 141 <br /> Contact email MANUTREHAN@HOTMAIL.0 M 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: f2 o1534.0 2 <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: 01 74 <br /> Assigned to: Oc a A-(1-OSS <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ exempt from billing <br /> Processed through CERS Integration Wizard by: j f�Date: <br /> "--------------------------------------------------- <br /> Accounting: Reviewed by: � Date: 12/4 S Clerical: [ ] File [ ] Relabel i lie [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ------ ------------- <br /> PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1617-RETAIL MARKET>1000 SQ FT W/FOOD PREP PRO161886 JEFFREY WONG Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO534921 ARIS VELOSO Active [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0534922 not assigned Inactive [ ] [ ] <br /> 'I <br />