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SAN JOAQUIIrc;OUNTY ENVIRONMENTAL HEALTRVtPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/21/2014 <br /> Submitted on: 6/5/2014 10:30:15AM CERS ID: 10181013 <br /> Submitted by: Roger Batra Email: roger.batra@quikstop.com Facility ID in CERS: FA0002890 <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 FA0002890 <br /> Facility name QUIK STOP MARKET#2120* QUIK STOP MARKET#2120* 3 <br /> Site address 9321 N THORNTON RD 9321 N THORNTON RD 103 <br /> City Stockton STOCKTON 104 <br /> Zip code 95209 95209 <br /> 05 <br /> Facility phone 209-478-7149 (209)478-7149 102 <br /> Facility mailing address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 108a <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name QUIK STOP MARKET#2120* QUIK STOP MARKET#2120* 140 <br /> Address 4567 ENTERPRISE ST 4567 ENTERPRISE ST 143 <br /> FREMONT, CA 94538-7605 FREMONT, CA 94538-7605 144, 145, 146 <br /> Contact phone 510-445-2285 510-445-2285 141 <br /> Contact email mike.karvelot@quikstop.com roger.batra@quikstop.com 142 <br /> Mail invoices to Facility✓ <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 <br /> n �/J �1 (may [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: K,UI`� Date: U 1 N 1 <br /> ------ ` --[ ] -- - ---- ---- Y--- - --- <br /> Accounting: Reviewed by: —�Date: V Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> —A filled Surchar enfie --_ B --_ Date: <br /> ------- -- -- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> J Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1617-RETAIL MARKET> 1000 SO FT W/FOOD PREP PRO160306 NICHOLAS WIESEMAN Active [ ] [ ) <br /> 1921 -HMBP-Regular-Primary Location PR0519618 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONS/YR PRO518567 Fatina Zareef Active [ ] [ ] <br /> 2361 -UST FACILITY PR0231261 Fatina Zareef Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO507321 MICHAEL KITH Inactive [ ] [ ] <br />