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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/10/2014 <br /> Submitted on: 12/9/2014 2:39:40PM <br /> 997 <br /> Submitted by: Mark Tanis Email: mtanis@ocatnet.com CERS ID: FA000 <br /> Facility ID in CERS: FA0002801801 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001766 <br /> Owner name OCAT INC OCAT INC <br /> Mailing address 4306 Sisk Rd 4306 Sisk Rd 111 <br /> MODESTO, CA 95356113 <br /> MODESTO, CA 95356 114, 115, 11E <br /> Work phone 209-529-6802 209-529-6802 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002801 <br /> Facility name TACO BELL#22207 TACO BELL#22207 3 <br /> Site address 5115 WEST LN 5115 WEST LN 103 <br /> City Stockton 104 <br /> ZIP code 95210 95210 105 <br /> Facility phone 209-478-7336 (209)478-7336 <br /> 102 <br /> Facility mailing address 801 1 OTH ST 5TH FLR#2 STOCKTON 4306 Sisk Rd 108a <br /> MODESTO, CA 95354 MODESTO, CA 95356 108b,1080,102 <br /> BILLING INFORMATION <br /> Contact name TACO BELL#22207 TACO BELL#22207 140 <br /> Address 801 10TH ST 5TH FLR#2 4306 Sisk Rd 143 <br /> MODESTO, CA 95354 MODESTO, CA 95356 144, 145, 14( <br /> Contact phone 209-529-6802 209-529-6802 141 <br /> Contact email ty mtanis@ocatnet.com 1 q2 <br /> Mail invoices to Fse /-I <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ j full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: iU7 d Date: p ID ,ti <br /> Accounting: Reviewed by: Date:— <br /> ate:�� Clerical: File [ ] Relabel file [ ] Create new file <br /> [ ] Acct d [ ] Sur ge venfi d By _ Date_ <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1625-RESTAURANT/BAR 51-100 SEATS PRO163077 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO520653 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511081 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO534548 not assigned Inactive [ ] [ ] <br />