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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 3/6/2018 <br />Submitted on: 1/24/2018 10:13:41AM CERS ID: 10724521 <br />Submitted by: Barry Stirm Email: bstirm@comcast.net Facility ID in CERS: incorrect <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner: 2 <br />OW0015675 <br />Barry Stirm <br />12352 E State rt 12 <br />Lockeford, CA 95237 <br />209-200-2323 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023824 <br />Facility name <br />SUBWAY 67296 <br />Site address <br />1600 W GATE DR <br />City <br />LODI <br />ZIP code <br />95242 <br />Facility phone <br />209-200-2323 <br />Facility mailing address 1601 S. Lowersacramento Rd <br />Information after CIW processing CERS <br />(current submittal) field <br />Stirm Family Inc <br />Lodi, CA 95242 <br />BILLING INFORMATION <br />113 <br />Contact name <br />SUBWAY 67296 <br />Address <br />1601 S. Lowersacramento Rd <br />209-200-2323 <br />Lodi, CA 95242 <br />Contact phone <br />Not Specified <br />Contact email <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0541978 STEPHANIE RAMIREZ <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />Stirm Family Inc <br />111 <br />1153 Devine Dr <br />113 <br />Lodi, CA 95240 <br />114, 115, 116 <br />209-200-2323 <br />112 <br />Subway 67296 <br />3 <br />1600 W Gate Dr <br />103 <br />Lodi <br />104 <br />95242 <br />105 <br />209-200-2323 <br />102 <br />1153 Devine Dr 108a <br />Lodi, CA 95240 108b, 108c, 108d <br />Stirm Family Inc <br />140 <br />1153 Devine Dr <br />143 <br />Lodi, CA 95240 <br />144, 145, 146 <br />209-200-2323 <br />141 <br />bstirm@comcast.net <br />142 <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 yearnext calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: �'�� Date: 7 -_ <br />t J <br />Accounting: Reviewed by: Date. 3�gr �� Clerical: [ <br />] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified <br />By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING <br />THROUGH CIW <br />Record ID Employee name <br />Status Reactivated Inactivated <br />1617 - RETAIL MARKET > 1000 SQ FT W / FOOD PREP PR0541554 STEPHANIE RAMIREZ <br />Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0541978 STEPHANIE RAMIREZ <br />Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 0 chem units PR0541980 STEPHANIE RAMIREZ <br />Inactive <br />L,�-�qe i Pe 4 J &4 Cck r ^,Ae7Lo - <br />