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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/19/2014 <br /> Submitted on: 613/2014 12:39:24PM CERS ID: 10180643 <br /> Submitted by: Roger Batra Email: roger.batra'c@quikstop.com Facility ID in CERS FA0000684 <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 FA0000684 <br /> Facility name QUIK STOP MARKET#3125 QUIK STOP MARKET#3125 3 <br /> Site address 1580 W MAIN ST 1580 W MAIN ST 103 <br /> City RIPON RIPON 1Q4 <br /> Zip code 95366 95366 105 <br /> Facility phone 209-599-4261 (209) 599-4261 102 <br /> Facility mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 108a <br /> FREMONT, CA 945387605 FREMONT, CA 94538-7605 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name QUIK STOP MARKET#3125 QUIK STOP MARKET#3125 140 <br /> Address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 143 <br /> FREMONT, CA 945387605 FREMONT, CA 94538-7605 144, 145. 146 <br /> Contact phone 209-599-2251 510-445-2285 141 <br /> Contact email 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 [ ] CaIARP [ ] 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: [o•�°�`� 1 <br /> Accounting: Reviewed by: _ Date: Clerical: [File [ ] Relabel file [ ] Create new file <br /> [ ] Agat-15illed [ ] Surchp<e 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 /> 4 1615-RETAIL MKT 301-2000 SO FT(PRlEPKGD/LTD PREP; PRO161618 LISA MEDiNA Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location ! PR0519799 MICHAEL PARISSI Active [ ] [ ] <br /> 2220-SM HVV GEN <5 TONS/YR PRO521556 ELENA MANZO Active [ ] [ ] <br /> 2361 -UST FACILITY PR0231476 ELENA MANZO Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507257 ALISON YOUNGBLOOD Inactive [ ] [ ] <br />