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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 3/6/2018 <br />Submitted on: 1/24/2018 10:16:23AM <br />Submitted by: Barry Stirm Email: bstirm@comcast.net <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW proces 'ng <br />(current EC database) <br />Number of Facilities for this Owner : 2 <br />OW0015675 <br />Barry Stirm <br />12352 E State rt 12 <br />Lockeford, CA 95237 <br />209-200-2323 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0019044 <br />Facility name <br />Subway <br />Site address <br />612 W Lodi Ave <br />City <br />Lodi <br />ZIP code <br />95240 <br />Facility phone <br />209-200-2323 <br />Facility mailing address <br />612 W Lodi Ave <br />Lodi, CA 95240 <br />BILLING INFORMATION <br />Contact name <br />Barry Stirm <br />Address <br />12352 E State rt 12 <br />Lodi, CA 95240 <br />Contact phone <br />209-200-2323 <br />Contact email <br />bstirm@comcast.net <br />Mail invoices to <br />Account <br />CERS ID: 10708987 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Stirm Family Inc 111 <br />1153 Devine Dr 113 <br />Lodi, CA 95240 114, 115, 116 <br />209-200-2323 112 <br />Subway <br />3 <br />612 W Lodi Ave <br />103 <br />Lodi <br />104 <br />95240 <br />105 <br />209-200-2323 <br />102 <br />1153 Devine Dr 108a <br />Lodi, CA 95240 108b, 108c, 108d <br />Stirm Family Inc <br />140 <br />1153 Devine Dr <br />143 <br />Lodi, CA 95240 <br />144, 145, 146 <br />209-200-2323 <br />141 <br />bstirm@comcast.net <br />142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />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: �Av* Date: -L <br />Accounting: Reviewed by:_ Date: 3 I l 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 />1623 - RESTAURANT/BAR 1-20 SEATS PR0528128 STEPHANIE RAMIREZ Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0541498 STEPHANIE RAMIREZ Active [ ] [ ] <br />