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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 6/21/2017 <br />Submitted on: 6/21/2017 11:20:48AM CERS ID: 10708987 <br />Submitted by: Barry Stirm Email: bstirm@comcast.net Facility ID in CERS: incorrect <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner: 2 <br />OW0015675 <br />STIRM, BARRY C <br />12352EHWY 12 <br />LOCKEFORD, CA 95237 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0019044 <br />Facility name <br />SUBWAY <br />Site address <br />612 W LODI AVE STE 106 <br />City <br />LODI <br />ZIP code <br />95240 <br />Facility phone <br />209-200-2323 <br />Facility mailing address <br />12352 E HWY 12 <br />12352 E State rt 12 <br />LOCKEFORD, CA 95237 <br />BILLING INFORMATION <br />114, 115, 116 <br />Contact name <br />SUBWAY <br />Address <br />12352 E HWY 12 <br />LOCKEFORD, CA 95237 <br />Contact phone <br />209-200-2323 <br />Contact email <br />Mail invoices to <br />Facility <br />Information after CIW processing CERS <br />(current submittal) field <br />Barry Stirm <br />111 <br />12352 E State rt 12 <br />113 <br />Lockeford, CA 95237 <br />114, 115, 116 <br />209-200-2323 <br />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 />612 W Lodi Ave 108a <br />Lodi, CA 95240 108b, 1oec, 1o8a <br />Barry Stirm <br />140 <br />12352 E State rt 12 <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: I7vh r Date: (-*-01I'17 <br />---------------------------------------------- <br />Accounting: Reviewed by: UJ Date: V/114111Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />-------------------------------------------------- <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 I ] I ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PRO541498 STEPHANIE RAMIREZ Active I ] I ] <br />'(n40 oky QCT lrJ�� /^v2�L11- 00MNn <br />t <br />