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SAN JOAQUIN COUMIY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/28/2017 <br /> Submitted on: 11/14/2017 3:15:46PM CERS ID: 10180803 <br /> Submitted by: Deanne Sbragia Email: deannesbragia@yahoo.com <br /> Facility ID in CERS: FA0001738 <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 OW0001352 <br /> Owner name SBRAGIA, LARRY SBRAGIA, LARRY 111 <br /> Mailing address 2324 GRAND CANAL#4 2324 GRAND CANAL#4 113 <br /> STOCKTON, CA 95207 STOCKTON, C 95207 114, 115, 116 <br /> Work phone 209-478-6290 (209)478-6290 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001738 <br /> Facility name BASILS PLACE BASILS PLACE 3 <br /> Site address 2324 GRAND CANAL BLVD#4 2324 GRAND CANAL BLVD 4 103 <br /> City STOCKTON STOCKTON <br /> ZIP code 95207 95207 104 <br /> Facility phone 209-478-6290105 <br /> (209)478-6290 102 <br /> Facility mailing address 2324 GRAND CANAL#4 2324 GRAND CANAL#4 108a <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name BASILS PLACE BASILS PLACE 140 <br /> Address 2324 GRAND CANAL#4 2324 GRAND CANAL#4 143 <br /> Stockton, CA 95207 Stockton, CA 95207 144, 145, 146 <br /> Contact phone 209-478-6290 (209)478-6290 141 <br /> Contact email <br /> Mail invoices to Account 142 <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA <br /> [ ] 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: t�z' Date: [ -2(�4-[-7 <br /> -------------- ------ -- ------ ____ __ _______ <br /> Accounting: Reviewed by: Date: 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 Emolovee na Status Reactivated Inactivated <br /> RESTAURANT/BAR 21-50 SEATS PRO160391 MARIBEL FLOHRSCHUT ctive I I I <br /> 1'J 9 HMBP-0O2 Only Food FaciliKi cilem units PR0530819 —�'-'= ,ivTi. Active [ I I <br /> C-ELECTRONIC REPORTINOSTA?E SURC♦=1ARGE FI PRO532276 Inactive [ I [ <br /> L' LtKl% ��� �, P\ Sill (or 9 <br /> S��r•� -� 'In N'�0. w5 �Qr <br /> bow <br /> wj4j 0- I <br /> it <br />