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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date-_ 6/20/2014 <br /> Submitted on: 6/3/2014 9:44:52AM CERS ID: 10180695 <br /> Submitted by: Roger Batra Email: roger.batra@quikstop.com <br /> Facility ID in CERS: FA0001060 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000478 <br /> Owner name QUIK STOP MARKETS INC QUIK STOP MARKETS INC 111 <br /> Mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 113 <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 114, 115, 116 <br /> Work phone 510-657-8500 510-657-8500 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001060 <br /> Facility name QUIK STOP MARKET#2076* QUIK STOP MARKET#2076* 3 <br /> Site address 1030 S OLIVE ST 1030 S OLIVE ST 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 95205 95205 105 <br /> Facility phone 209-948-6731 (209) 948-6731 102 <br /> Facility mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 108a <br /> FREMONT, CA 945387605 FREMONT, CA 94538-7605 108b,108c,1086 <br /> BILLING INFORMATION <br /> Contact name QUIK STOP MARKET#2076* QUIK STOP MARKET#2076* 140 <br /> Address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 143 <br /> FREMONT, CA 945387605 FREMONT, CA 94538-7605 144, 145, 146 <br /> Contact phone 209-957-2411 510-445-2285 141 <br /> Contact emailJ roger.batra@quikstop.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ j RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ J CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ J full calendar year [ ] prorate this <br /> _calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: wi` Date: <br /> --------------------------------- <br /> - —9---- ---------- --------- —Y------------- <br /> Accounting: <br /> -- ---- --- <br /> Accountin Reviewed by:�Date: Clerical: [ File [ ] Relabel file [ ] Create new file <br /> [ ] A Illed [ ] Surc a verlfie B : Date: <br /> ------------------ <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1921 -HMBP-Regular-Primary Location PRO520229 LOWELLALLEN Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0518566 JEFFREY WONG Active <br /> 2301 -UST STATE SURCHARGE FEE PRO508368 LETITIA BRIGGS Inactive [ ] [ ] <br /> 2361 -UST FACILITY PR0231704 JEFFREY WONG Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507268 LETITIA BRIGGS Inactive [ ] [ ] <br /> 3123-STORMWATER INSPECTION-RETAIL GAS OUTLET PR0523016 JEFFREY WONG Inactive [ ] [ ] <br />