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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/15/2017 <br />Submitted on: 6/14/2017 2:06:33PM CERS ID: 10184173 <br />Submitted by: Kristal Helfrich Email: kristal@raymerbusiness.com Facility ID in CERS: FA0012257 <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 : 5 <br />OW0009994 <br />WOMAR INC <br />4749 Bennett Drive, Suite I <br />Livermore, CA 94551 <br />192-529-2102 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0012257 <br />Facility name <br />CARLS JR #7481 <br />Site address <br />3205 W HAMMER LN <br />City <br />STOCKTON <br />ZIP code <br />95209 <br />Facility phone <br />209-476-1091 <br />Facility mailing address 4749 BENNETT DR, STE I <br />Information after CIW processing CERS <br />(current submittal) field <br />WOMAR INC 111 <br />4749 Bennett Drive, Suite 1 113 <br />Livermore, CA 94551 114, 115, 116 <br />19252921024 112 <br />CARLS JR #7481 <br />LIVERMORE, CA 94551 <br />BILLING INFORMATION <br />103 <br />Contact name <br />CARLS JR #7481 <br />Address <br />4749 BENNETT DR, STE I <br />(209) 476-1091 <br />LIVERMORE, CA 94551 <br />Contact phone <br />Not Specified <br />Contact email <br />108b, 108c, 108d <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />WOMAR INC 111 <br />4749 Bennett Drive, Suite 1 113 <br />Livermore, CA 94551 114, 115, 116 <br />19252921024 112 <br />CARLS JR #7481 <br />3 <br />3205 W HAMMER LN <br />103 <br />STOCKTON <br />104 <br />95209 <br />105 <br />(209) 476-1091 <br />102 <br />4749 Bennett Drive, Suite I <br />108a <br />Livermore, CA 94551 <br />108b, 108c, 108d <br />KRISTAL HELFRICH 140 <br />4749 Bennett Drive, Suite 1 143 <br />Livermore, CA 94551 144, 145, 146 <br />19252921024 141 <br />KRISTAL@RAYMERBUSINESS.COM 142 <br />Program record [ ] HMBP [ ] SOG 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 this calendar year [ ] next calendar year [ ] exempt from billing <br />(9 1 <br />Processed through CERS Integration Wizard by: r 71 D�- « 7 <br />Date: �- <br />-1 l <br />Accounting: Reviewed by: (6 Date: &11&1(% Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />-------------------------------------- <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1625 - RESTAURANT/BAR 51-100 SEATS PRO515633 STEPHANIE RAMIREZ Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0522825 STEPHANIE RAMIREZ Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PRO532408 not assigned Inactive [ ] [ ] <br />