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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 7/14/2015 <br />Submitted on: 7/9/2015 4:26:12PM <br />Submitted by: Amanda Ponce Email: amanda.ponce@pandarg.com <br />CERS ID: 10636291 <br />Facility ID in CERS: incorrect <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Owner ID <br />OW0011593 <br />Owner name <br />PANDA EXPRESS, INC <br />Panda Restaurant Group, Inc. <br />111 <br />Mailing address <br />1683 WALNUT GROVE AVE <br />1683 Walnut Grove Avenue <br />113 <br />ROSEMEAD, CA 91770 <br />Rosemead, CA 91770 <br />114, 115, 116 <br />Work phone <br />626-799-9898 <br />(626) 799-9898 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0016106 <br />Facility name <br />PANDA EXPRESS #1023 <br />Panda Express #1023 <br />3 <br />Site address <br />1467 HULSEY WAY <br />1467 Hulsey Way <br />103 <br />City <br />MANTECA <br />Manteca <br />104 <br />ZIP code <br />95336 <br />95336 <br />105 <br />Facility phone <br />209-824-8267 <br />(209) 824-5893 <br />102 <br />Facility mailing address <br />1683 WALNUT GROVE AVE <br />1467 Husley Way <br />108a <br />ROSEMEAD, CA 91770 <br />Manteca, CA 95336 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name <br />PANDA EXPRESS #1023 <br />Panda Restaurant Group PX1023 <br />140 <br />Address <br />1683 WALNUT GROVE AVE <br />1683 Walnut Grove Avenue <br />143 <br />ROSEMEAD, CA 91770 <br />Rosemead, CA 91770 <br />144, 145, 146 <br />Contact phone <br />209-824-8267 <br />(626) 799-9898 <br />141 <br />Contact email <br />amanda.ponce@pandarg.com <br />142 <br />Mail invoices to <br />Facility <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW <br />[ ] RCRA HW New PR#: <br />created [ ] Tiered <br />permit [ ] APSA [ ] CalARP <br />[ ] 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: 4 Date: / 6 <br />-------------------------------------------------- <br />Accounting: Reviewed by: �_ Date: g�3�,� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed 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 PR0523936 KADEANNE LINHARES Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location PRO540257 NICHOLAS LOEHRER Active [ ] [ ] <br />