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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 9/28/2015 <br />Submitted on: 9/15/2015 1:30:11 PM <br />Submitted by: Camran Nojoomi Email: cnojoomi@ashria.com <br />CERS ID: 10186961 <br />Facility ID in CERS: FA0018717 <br />Employee name <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Owner ID <br />OW0015383 <br />City <br />STOCKTON <br />Owner name <br />ASHRIA LLC <br />Ashria LLC <br />111 <br />Mailing address <br />1508 EUREKA RD STE 140 <br />1200 Anderson Dr <br />113 <br />(209)477-4833 <br />ROSEVILLE, CA 95661-2819 <br />Suisun City, CA 94585 <br />114, 115, 116 <br />Work phone <br />209-477-4833 <br />707-803-2816 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0018717 <br />Employee name <br />Status Reactivated Inactivated <br />Facility name <br />STOCKTON POPEYES CHICKEN & BISCU <br />ASHRIA LLC <br />3 <br />Site address <br />4966 WEST LN <br />4966 WEST LN <br />103 <br />City <br />STOCKTON <br />STOCKTON <br />104 <br />ZIP code <br />95210 <br />95201 <br />105 <br />Facility phone <br />209-477-4833 <br />(209)477-4833 <br />102 <br />Facility mailing address <br />1508 EUREKA RD STE 140 <br />4966 W Ln <br />108a <br />ROSEVILLE, CA 95661-2819 <br />Stockton, CA 95210 <br />108b. 108c, 108d <br />BILLING INFORMATION <br />Contact name <br />STOCKTON POPEYES CHICKEN & BISCU <br />Ashria LLC <br />140 <br />Address <br />1508 EUREKA RD STE 140 <br />1200 Anderson Dr <br />143 <br />ROSEVILLE, CA 95661-2819 <br />Suisun City, CA 94585 <br />144, 145, 146 <br />Contact phone <br />Not Specified <br />707-803-2816 <br />141 <br />Contact email <br />cnojoomi@ashria.com <br />142 <br />Mail invoices to <br />Facility <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ <br />] RCRA HW New PR#: <br />created [ ] Tiered <br />permit [ ] APSA [ ] CalARP [ <br />] UST New PE: <br />Assigned to: <br />Please bill: [ ] full <br />calendar year [ ] prorate this calendar year <br />[ ] next calendar year [ <br />] exempt from billing <br />Processed through CERS Integration Wizard by: Date: <br />Accounting: Reviewed by: Date: hof /1 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 />1624 - RESTAURANT/BAR 21-50 SEATS <br />PR0527622 <br />JEFFREY WONG <br />Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location <br />PR0530841 <br />HAZA SAEED <br />Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI <br />PR0534306 <br />not assigned <br />Inactive [ ] [ ] <br />