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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/23/2017 <br /> Submitted on: 6/19/2017 11:12:40AM CERS ID: 10180633 <br /> Submitted by: Lakhwinder Sandhu Email: sunny549@hotmail.com Facility ID in CERS: FA0000645 <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 OW0000515 <br /> Owner name Kaur Surinder LAKHWINDER SINGH SANDHU 111 <br /> Mailing address 20 W TURNER RD A 586 Stoneygate Dr 113 <br /> LODI, CA 95240 Galt, CA 95632 114, 115, 116 <br /> Work phone 209-369-3697 209-327-6171 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000645 <br /> Facility name SHORT STOP FOOD MART SHORT STOP FOOD MART 3 <br /> Site address 20 W TURNER RD 20 W TURNER RD A 103 <br /> City LODI LODI 104 <br /> ZIP code 95240 95240 105 <br /> Facility phone 209-369-3697 209-369-3697 102 <br /> Facility mailing address 20 W TURNER RDA 20 W TURNER RD A 108a <br /> LODI, CA 95240 LODI, CA 95240 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name LAKHWINDER SANDHU LAKHWINDER SINGH SANDHU 140 <br /> Address 20 W TURNER RD A 20 W TURNER RD A 143 <br /> LODI, CA 95240 LODI, CA 95240 144, 145, 146 <br /> Contact phone 209-369-3697 209-369-3697 141 <br /> Contact email dshartist@sbcglobal.net lakhwinder.sandhu@yahoo.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 /> n nn <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by: 14b —Date: tX ? 0 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1617-RETAIL MARKET> 1000 SQ FT W/FOOD PREP PRO160279 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location 3 chem units PR0520474 JAMIE LIMA Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PR0518595 ONE VACANT1 Active [ ] [ ] <br /> 2361 -UST FACILITY PR0231380 ONE VACANT1 Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513052 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2301 -UST STATE SURCHARGE FEE PR0516160 ONE VACANT1 Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507255 ONE VACANT1 Inactive <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO531842 not assigned Inactive [ ] [ ] <br /> �.�^�ir,.�r.1� ��t�� c.h /,�� (�L�r��-�-� �7���y �:•�� -��(-� U�+rr,xt5i,� . �v� �.' <br />