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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 11/28/201E <br />Submitted on: 11/14/2016 4:20:13PM <br />Submitted by: Jim Toal Email: justwinginit@sbcglobal.net <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 : 1 <br />OW0017924 <br />Just Wingin It Inc <br />2612 Barola Ln. <br />Modesto, CA 95356 <br />209-985-5700 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0021776 <br />Facility name <br />Wing Stop <br />Site address <br />1342 E Yosemite Ave <br />City <br />Manteca <br />ZIP code <br />95336 <br />Facility phone <br />209-572-3544 <br />Facility mailing address <br />2612 Barola Ln <br />Modesto, CA 95356 <br />BILLING INFORMATION <br />Contact name <br />Wing Stop <br />Address <br />2612 Barola Ln <br />Modesto, CA 95356 <br />Contact phone <br />Not Specified <br />Contact email <br />robin. springcreek@gmail.com <br />Mail invoices to <br />Account <br />CERS ID: 10643371 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Just Wingin It, Inc 111 <br />2612 Barola Ln. 113 <br />Modesto, CA 95356 114, 115, 116 <br />209-985-5700 112 <br />Wing Stop <br />3 <br />1342 E Yosemite Ave <br />103 <br />Manteca <br />104 <br />95336 <br />105 <br />209-824-9464 <br />102 <br />2612 Barola Ln. 108a <br />Modesto, CA 95356 108b, 108c, 108d <br />Robin Velthoen 140 <br />3608 Corte Madera 143 <br />Modesto, CA 95356 144, 145, 146 <br />209-479-4455 141 <br />robin.springcreek@gmail.com 142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: <br />New PE: _ <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate thiscalendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: /"� Date: <br />Accounting: Reviewed by: bib Date: W 10/(- 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 Record ID Employee name Status Reactivated Inactivated <br />1624 - RESTAURANT/BAR 21-50 SEATS PR0537768 KADEANNE LINHARES Active I ] I ] <br />1919 - HMBP-0O2 Only Food Facility PR0540281 KADEANNE LINHARES Active I ] I ] <br />