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SAN JOAQUIN ,JUNTY ENVIRONMENTAL HEALTH LcPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/10/2016 <br /> Submitted on: 5/11/2016 10:27:26AM CERS ID: 10671499 <br /> Submitted by: Larry Burton Email: larry@temarry.com Facility ID in CERS: incorrect <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 : 3 <br /> Owner ID OW0000330 0A)D1)"-,4 ldr� <br /> Owner name MERVYN"S LLC JACK JOHNSTON 111 <br /> Mailing address 22301 FOOTHILL BLVD 7707 SW 44TH STREET 113 <br /> HAYWARD, CA 94541 OKLAHOMA CITY, OK 73179 114, 115, 116 <br /> Work phone Not Specified 4057451351 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001205 <br /> Facility name MERVYNS#41 HOBBY LOBBY 3 <br /> Site address 1155 W MARCH LN 1155 W March Ln 103 <br /> City STOCKTON Stockton 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone Not Specified 4057451351 102 <br /> Facility mailing address 22301 FOOTHILL BLVD 1155 W. MARCH LN 108a <br /> HAYWARD, CA 94541 STOCKTON, CA 95207 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name MERVYNS#41 DAVID EPSTEIN 140 <br /> Address 22301 FOOTHILL BLVD P.O. BOX 339 143 <br /> HAYWARD, CA 94541 RICHLAND, NJ 08350 144, 145, 146 <br /> Contact phone 510-727-3000 8564577798 141 <br /> Contact email depstein@theuscg.com 142 <br /> Mail invoices to Fticility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ) RCRAHW New PR#: `[ I C) <br /> created [ ] Tiered permit [ ] APSA [ ) CalARP [ ) UST -New PE: <br /> l 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: 4 Date: <br /> F <br /> Accounting: Reviewed by: 1/6 Date: I`� t Clerical: [ ] File ) Relabel file [ ] Create new file <br /> Acct billed [�urcharge verified- _ By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Descri tion Record ID Employee name Status Reactivated Inactivated <br /> 1615-RETAIL MKT 301-2000 SQ FT(PREPKGD/LTD PREP; PRO162598 VIDAL PEDRAZA Inactive I I I I <br />