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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: 1/13/2015 3:15:57PM CERS ID: 10421704 <br /> Submitted by: Ken Ilejay Email: kilejay@savemart.com Facility ID in CERS: FA0002617 <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 FA0002617 <br /> Facility name S-Mart#91 S-Mart#91 3 <br /> Site address 7506 Pacific Ave 7506 Pacific Ave 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-951-7825 209-951-7825 102 <br /> Facility mailing address PO BOX 4664 1800 Standiford Ave. 108a <br /> Modesto, CA 95352 Modesto, CA 95350 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name S-Mart#91 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 j 209-574-6292 141 <br /> Contact email lorna@savemart.com✓/ lorna@savemart.com 142 <br /> Mail invoices to Account <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: [ 1�i-1 7 <br /> Accounting: Reviewed by: LCL Date: Z /D ! Clerical: XFile [ ] 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 FT(=/>2 DEPTS) PRO160960 MARI BEL FLOHRSCHUTZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0539364 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0539363 FATINAH ZAREEF Active [ ] [ ] <br />