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Date run 6/30/2015 2:08:08PNSANWQUIN COUNTY ENVIRONMENTAL HI.THDEPARTMENT Report 715021 <br /> Run by Pagel <br /> Facility Information as of 6/30/2015 <br /> Record Selection Criteria: Facility ID FA0018361 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 7 SSN/Fed Tax ID <br /> Owner ID OW0011593 New Owner ID <br /> Owner Name PANDA EXPRESS, INC <br /> Owner DBA PANDA EXPRESS <br /> OwnerAddress 1683 WALNUT GROVE AVE <br /> ROSEMEAD, CA 91770 <br /> Home Phone 626-799-2331 <br /> Work/Business Phone 626-799-9898 <br /> Mailing Address 1683 WALNUT GROVE AVE <br /> ROSEMEAD, CA 91770 <br /> Care of TAX/LICENSEDEPT <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0018361 <br /> Facility Name PANDA EXPRESS#1434 <br /> Location 2130 DANIELS ST <br /> MANTECA, CA 95337 <br /> Phone <br /> Mailing Address 1683 WALNUT GROVE AVE <br /> ROSEMEAD, CA 91770 <br /> Care of TAX/LICENSEDEPT <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 24153011 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> ContactName PANDA EXPRESS <br /> Title <br /> Day Phone <br /> Night Phone 626-799-9898 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032381 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility ! Account <br /> Account Name PANDA EXPRESS#1434 (Circle One) <br /> Account Balance as of 6/30/2015: $0.00 <br /> (Circle One) <br /> Transfer to ActiveMactve <br /> Program/Element and Description Record 10 Employee ID and Name Status New OwneR Delete <br /> 1624-RESTAURANT/BAR 21-50 SEATS PR0527083 EE0004589-KADEANNE LINHARES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acimowledge that all site,andior project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anclior Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: Inv ice#: <br />