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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/21/2017 <br /> Submitted on: 6/21/2017 11:19:56AM CERS ID: 10724521 <br /> Submitted by: Barry Stirm Email: bstirm@comcast.net Facility ID in CERS: incorrect <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 2 <br /> Owner ID OW0015675 <br /> Owner name Barry Stirm Barry Stirm 111 <br /> Mailing address 12352 E State rt 12 12352 E State rt 12 113 <br /> Lockeford, CA 95237 Lockeford, CA 95237 114, 115, 116 <br /> Work phone 209-200-2323 209-200-2323 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0023824 <br /> Facility name SUBWAY#67296 Subway 67296 3 <br /> Site address 1600 WEST GATE DR 1600 W Gate Dr 103 <br /> City LODI Lodi 104 <br /> ZIP code 95242 95242 105 <br /> Facility phone 209-452-2499 209-200-2323 102 <br /> Facility mailing address 12352 E HWY 12 1601 S. Lowersacramento Rd. 108a <br /> LOCKEFORD, CA 95237 Lodi, CA 95242 108b,108c,load <br /> BILLING INFORMATION <br /> Contact name SUBWAY#67296 Stirm Family Inc 140 <br /> Address 12352 E HWY 12 12352 E State rt 12 143 <br /> LOCKEFORD, CA 95237 Lockeford, CA 95237 144, 145, 146 <br /> Contact phone 209-200-2323 209-200-2323 141 <br /> Contact email bstirm@comcast.net 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG 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: r Date: (0-,;Ll-k-7 <br /> -------------------------------------------------- <br /> Accounting: Reviewed by: 16 Date: W-1141-1 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 /> 1617-RETAIL MARKET> 1000 SQ FT W/FOOD PREP PR0541554 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1919-HM13P-CO2 Only Food Facility 1 chem units PR0541978 STEPHANIE RAMIREZ Active [ ] [ ] <br /> 1919-HMBP-0O2 Only Food Facility 0 chem units PR0541980 STEPHANIE RAMIREZ Inactive [ ] [ ] <br />