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E- SAN JOA( COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/19/2014 <br /> Submitted on: 6/3/2014 2:55:57PM CERS ID: 10180641 <br /> Submitted by: Roger gatra Email: roger.batra@quikstop.com Facility ID in CERS: FA0000670 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000478 <br /> Owner name QUIK STOP MARKETS INC QUIK STOP MARKETS INC 111 <br /> Mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 113 <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 114, 115, 116 <br /> Work phone 510-657-8500 510-657-8500 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000670 <br /> Facility name QUIK STOP MARKET#3148* QUIK STOP MARKET#3148* 3 <br /> Site address 205 W LOCKEFORD ST 205 W LOCKEFORD ST 103 <br /> City Lodi LODI 104 <br /> .Zip code 95240 95240 105 <br /> Facility phone 209-369-1142 (209) 369-1142 102 <br /> Facility mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 108a <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name QUIK STOP MARKET#148 QUIK STOP MARKET#148 140 <br /> Address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 143 <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 144, 145, 146 <br /> Contact phone 510-445-2285 510-445-2285 141 <br /> Contact email mike.karvelot@quikstop.com roger.batra@quikstop.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 [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed b : _ Date: Clerical: [,/j File [ ] Relabel file [ ] Create new file <br /> [ ] Ac Illed [ j Surch _ venfled __ _ By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1617-RETAIL MARKET> 1000 SO FT W/FOOD PREP PRO162385 KADEANNE LINHARES Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0519766 JAMIE DE LA ROSA Active [ ] [ J <br /> 2220-SM HW GEN<5 TONS/YR PRO518707 ARIS VELOSO Active [ ] [ J <br /> 2301 -UST STATE SURCHARGE FEE PR0507714 GARRETT BACKUS Inactive [ ] [ ] <br /> 2361 -UST FACILITY PR0232257 ARIS VELOSO Active [ ] [ J <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507256 GARRETT BACKUS Inactive [ ] [ J <br />