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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/23/2017 Submitted on: 6/19/2017 11:12:40AM Submitted by: Lakhwinder Sandhu Email: sunny549@hotmail.com OWNER INFORMATION Owner ID Owner name Mailing address Work phone Information prior to CIW processing (current EC database) Number of Facilities for this Owner : 1 OW0000515 Kaur Surinder 20 W TURNER RD A LODI, CA 95240 209-369-3697 FACILITY FILE INFORMATION Facility ID FA0000645 Facility name SHORT STOP FOOD MART Site address 20 W TURNER RD City LODI ZIP code 95240 Facility phone 209-369-3697 Facility mailing address 20 W TURNER RD A CERS ID: 10180633 Facility ID in CERS: FA0000645 Information after CIW processing CERS (current submittal) field LAKHWINDER SINGH SANDHU 111 586 Stoneygate Dr 113 Galt, CA 95632 114, 115, 116 209-327-6171 112 SHORT STOP FOOD MART 3 20 W TURNER RD A 103 LODI 104 95240 105 209-369-3697 102 20 W TURNER RD A 108a LODI, CA 95240 108b, 108c, 108d LAKHWINDER SINGH SANDHU 140 20 W TURNER RD A 143 LODI, CA 95240 144, 145, 146 209-369-3697 141 lakhwinder.sandhu@yahoo.com 142 Program record [ J HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: ?/ova � Date: Accounting: Reviewed by: Date: ? Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] Acct billed [ ] Surcharge verified By: Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Record ID Employee name Status Reactivated Inactivated 1617 - RETAIL MARKET > 1000 SQ FT W / FOOD PREP PRO160279 STEPHANIE RAMIREZ Active [ ] [ ] 1921 - HMBP-Regular-Primary Location 3 chem units PR0520474 JAMIE LIMA Active [ ] [ ] 2220 - SM HW GEN <5 TONS/YR PR0518595 ONE VACANT1 Active [ ] [ ] 2361 - UST FACILITY PR0231380 ONE VACANT1 Active [ ] [ ] 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513052 HAZ MAT SJC OES Inactive [ ] [ ] 2301 - UST STATE SURCHARGE FEE PR0516160 ONE VACANT1 Inactive [ ] [ ] 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507255 ONE VACANT1 Inactive [ ] [ ] ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR055331842 not assigniedd Inactive [ ] [ ] cvh ()e"' ice, � LODI, CA 95240 BILLING INFORMATION Contact name LAKHWINDER SANDHU Address 20 W TURNER RD A LODI, CA 95240 Contact phone 209-369-3697 Contact email dshartist@sbcglobal.net Mail invoices to Account CERS ID: 10180633 Facility ID in CERS: FA0000645 Information after CIW processing CERS (current submittal) field LAKHWINDER SINGH SANDHU 111 586 Stoneygate Dr 113 Galt, CA 95632 114, 115, 116 209-327-6171 112 SHORT STOP FOOD MART 3 20 W TURNER RD A 103 LODI 104 95240 105 209-369-3697 102 20 W TURNER RD A 108a LODI, CA 95240 108b, 108c, 108d LAKHWINDER SINGH SANDHU 140 20 W TURNER RD A 143 LODI, CA 95240 144, 145, 146 209-369-3697 141 lakhwinder.sandhu@yahoo.com 142 Program record [ J HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: ?/ova � Date: Accounting: Reviewed by: Date: ? Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] Acct billed [ ] Surcharge verified By: Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Record ID Employee name Status Reactivated Inactivated 1617 - RETAIL MARKET > 1000 SQ FT W / FOOD PREP PRO160279 STEPHANIE RAMIREZ Active [ ] [ ] 1921 - HMBP-Regular-Primary Location 3 chem units PR0520474 JAMIE LIMA Active [ ] [ ] 2220 - SM HW GEN <5 TONS/YR PR0518595 ONE VACANT1 Active [ ] [ ] 2361 - UST FACILITY PR0231380 ONE VACANT1 Active [ ] [ ] 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513052 HAZ MAT SJC OES Inactive [ ] [ ] 2301 - UST STATE SURCHARGE FEE PR0516160 ONE VACANT1 Inactive [ ] [ ] 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0507255 ONE VACANT1 Inactive [ ] [ ] ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR055331842 not assigniedd Inactive [ ] [ ] cvh ()e"' ice, �