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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 12/1/2015 <br />Submitted on: 11/30/2015 12:10:47PM <br />Submitted by: Jesse Diaz Email: jesse.diaz@loves.com <br />OWNER INFORMATION <br />Owner I D <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 />OW0009856 <br />LOVES COUNTRY STORES OF CA <br />PO BOX 26210 <br />OKLAHOMA CITY, OK 73126 <br />405-302-6638 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0021886 <br />Facility name <br />Love's Travel Stop #538 <br />Site address <br />15250 N THORNTON RD <br />City <br />Lodi <br />ZIP code <br />95242 <br />Facility phone <br />405-687-1060 <br />Facility mailing address <br />PO Box 26210 <br />15250 North Thornton Road <br />Oklahoma City, OK 73126 <br />BILLING INFORMATION <br />104 <br />Contact name <br />Love's Country Stores of CA <br />Address <br />PO Box 26210 <br />I <br />PO Box 26210 <br />Oklahoma City, OK 73126 <br />Contact phone <br />405-302-6638 <br />Contact email <br />jesse.diaz@loves.com <br />Mail invoices to <br />Account <br />CERS ID: 10448341 <br />Facility IP in CERS: FA0021886 <br />Information after CIW processing CERS <br />(current submittal) field <br />Love's Travel Stops and Country Stores 111 <br />PO BOX 26210 113 <br />Oklahoma City, OK 73126 114, 115, 116 <br />(405) 242-2455 112 <br />Love's Travel Stop #538 <br />3 <br />15250 North Thornton Road <br />103 <br />Lodi <br />104 <br />95242 <br />105 <br />(405) 687-1060 <br />102 <br />I <br />PO Box 26210 <br />108a <br />Oklahoma City, OK 73126 <br />108b, 10sc, 1084 <br />Love's Country Stores of CA 140 <br />PO Box 26210 143 <br />Oklahoma City, OK 73126 144, 145, 146 <br />(405) 302-6638 141 <br />jesse.diaz@loves.com 142 <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 [ j exempt from billing <br />Processed through CERS Integration Wizard by: VA Date: <br />-------------------------------------------------- <br />Accounting: Reviewed by: Iib Date: 12Vl Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description <br />Record ID <br />Employee name <br />Status Reactivated Inactivated <br />1625 - RESTAURANT/BAR 51-100 SEATS <br />PR0540031 <br />STEPHANIE RAMIREZ <br />Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location <br />PR0539990 <br />JAMIE DE LA ROSA <br />Active [ ] [ l <br />2220 - SM HW GEN <5 TONS/YR <br />PR0539989 <br />ARIS VELOSO <br />Active [ ] [ ] <br />2351 - UST FACILITY - 2481 COMPLIANT <br />PR0537919 <br />ARIS VELOSO <br />Active [ ] [ ] <br />2832 - AST FAC 10 K - </=100 K GAL CUMULATIVE <br />PR0539991 <br />not assigned <br />Active [ ] [ ] <br />4740 - WASTE TIRE SITE - EXEMPT <br />PR0538168 <br />ALFONSO ARAMBULA <br />Active [ ] [ ] <br />