Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/27/2017 <br />Submitted on: 4/3/2017 8:19:14AM <br />Submitted by: Licensing Coordinator Email: licensing@buffalowildwings.com <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 : 1 <br />OW0021808 <br />BLAZIN WINGS INC <br />5500 WAYZATA BLVD STE 1600 <br />MINNEAPOLIS, MN 55416 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023527 <br />Facility name <br />BUFFALO WILD WINGS <br />Site address <br />1537 S LOWER SACRAMENTO RD STE 11 <br />City <br />LODI <br />ZIP code <br />95242 <br />Facility phone <br />209-365-1693 <br />Facility mailing address 5500 WAYZATA BLVD STE 1600 <br />MINNEAPOLIS, MN 55416 <br />BILLING INFORMATION <br />Contact name BUFFALO WILD WINGS <br />Address 5500 WAYZATA BLVD STE 1600 <br />MINNEAPOLIS, MN 55416 <br />Contact phone 952-593-9943 <br />Contact email <br />Mail invoices to Facility <br />CERS ID: 10731559 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Blazin Wings, Inc. 111 <br />Attn: Licenisng Dept., 5500 Wayzata Blvd.,! 113 <br />minneapolis, MN 55416 114, 115, 116 <br />952-593-9943 112 <br />Buffalo Wild Wings 664 3 <br />1537 South Lower Sacramento Road, Suite 103 <br />Lodi 104 <br />95242 105 <br />209-365-1693 102 <br />1537 South Lower Sacramento Road, Suite 108a <br />Lodi, CA 95242 108b, 108c, 108d <br />Blazin Wings, Inc. - Attn: Licensing Dept. 140 <br />5500 Wayzata Blvd., Suite 1600 143 <br />Minneapolis, MN 55416 144, 145, 146 <br />952-593-9942 141 <br />licensing@buffalowildwings.com 142 <br />Program record [ ] HMBP [ ] SQG 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 />Processed through CERS Integration Wizard by: 0!, ,- ' -- Date: I'l' 2-7"1-7 <br />------------------------------------- <br />Accounting: Reviewed by: L/6 Date: 5/il�'� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ]Acct billed— [1 Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1626 - RESTAURANT/BAR 101 + SEATS PR0541090 STEPHANIE RAMIREZ Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0541636 STEPHANIE RAMIREZ Active [ ] [ ] <br />