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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run' 10/5/2015 <br />Submitted on: 10/2/2015 3:46:38PM <br />Submitted by: Camran Nojoomi Email: cnojoomi@ashria.com <br />CERS ID: 10186961 <br />Facility ID in CERS: FA0018717 <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 />1200 Anderson Dr <br />1200 Anderson Dr <br />113 <br />(209)477-4833 <br />Suisun City, CA 94585 <br />Suisun City, CA 94585 <br />114, 115, 116 <br />Work phone <br />707-803-2816 <br />707-803-2816 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0018717 <br />Facility name <br />STKN POPEYES CHICKEN & BISCUIT <br />Stockton Popeyes <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 />95201 <br />95201 <br />105 <br />Facility phone <br />209-477-4833 <br />(209)477-4833 <br />102 <br />Facility mailing address <br />4966 W Ln <br />4966 W -L -n- 44�k— <br />108a <br />Stockton, CA 95210 <br />Stockton, CA 95210 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name <br />STKN POPEYES CHICKEN & BISCUIT <br />Ashria LLC <br />140 <br />Address <br />4966 W Ln <br />1200 Anderson Dr <br />143 <br />Stockton, CA 95210 <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 />cnojoomi@ashria.com <br />142 <br />Mail invoices to <br />Account <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST <br />New PR#: _ <br />New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: kA Date: <br />Accounting: Reviewed by: J Pi) Date: 1 D & !S Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ]—Acct billed�1 Surcharge rve ified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated Inactivated <br />1624 - RESTAURANT/BAR 21-50 SEATS PR0527622 JEFFREY WONG Active (] [ ] <br />1921 - HMBP-Regular-Primary Location PRO530841 HAZA SAEED Active [ ] [ J <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PRO534306 not assigned Inactive [ ] [ ] <br />