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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 10/17/201 <br /> Submitted on: 10/16/2014 3:58:43PM CERS ID: 10181081 <br /> Submitted by: Joginder Lal Email: mall.narinder@gmail.com Facility ID in CERS: FA0003284 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0001454 <br /> Owner name LAL, JOGINDER LAL, JOGINDER 111 <br /> Mailing address 840 DUPONT DR 125 East Winnemucca Blvd. 113 <br /> STOCKTON, CA 95210 Winnemucca, NV 89445 114, 115, 116 <br /> Work phone 209-547-1700 775-421-9978 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003284 <br /> Facility name FOOD MART GASOLINE* FOOD MART GASOLINE* 3 <br /> Site address 2185 E FREMONT ST 2185 E FREMONT ST 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 95205 95205 105 <br /> Facility phone 209-547-1700 (209) 547-1700 102 <br /> Facility mailing address 2185 E FREMONT ST 2185 E FREMONT ST 108a <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 108b,108c,1084 <br /> BILLING INFORMATION <br /> Contact name FOOD MART GASOLINE* FOOD MART GASOLINE* 140 <br /> Address 2185 E FREMONT ST 125 East Winnemucca Blvd. 143 <br /> STOCKTON, CA 95205 Winnemucca, NV 89445 144, 145, 146 <br /> Contact phone 209-473-0534 209-547-1700 141 <br /> Contact email mall.narinder@gmail.com 142 <br /> Mail invoices to F y <br /> Program record [ ] HMBP [ ] SQG HW [ I LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST 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: VA Date: k b-0 44 <br /> --------------- -- ----------�------------------ <br /> Accounting: Reviewed by:�Date: Clerical:/If File [ ] Relabel file [ ] Create new file <br /> [ ] A,, t illed [ ] Surc a verified By: Date: <br /> -------------- <br /> --------------------------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1615-RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PREP; PRO161872 LEYNA HUYNH Active [ ] [ ] <br /> 1920-HMBP-Common Materials PR0522271 HAZA SAEED Active [ ] [ ] <br /> 2220-SM HW GEN<5 TONSNR PR0524255 JEFFREY WONG Active <br /> 2227-GEN 5<25 TONS PERMIT PR0505923 JEFFREYWONG Inactive [ ] [ ] <br /> 2371 -UST FACILITY-1702 COMPLIANT PR0231118 JEFFREY WONG Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO518523 FATINAH ZAREEF Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0532076 not assigned Inactive [ ] [ ] <br />