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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/17/2017 <br />Submitted on: 4/17/2017 12:24:36PM CERS ID: 10180713 <br />Submitted by: David Luu Email: luuchickenbowl@hotmail.com Facility ID in CERS: FA0001118 <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 : 3 <br />OW0005082 <br />LUU, DAVID HOANG <br />10521 OAKWILDE AVE <br />STOCKTON, CA 95212 <br />209-601-3893 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0001118 <br />Facility name <br />LUUS CHICKEN BOWL <br />Site address <br />300 N MAIN ST <br />City <br />MANTECA <br />ZIP code <br />95336 <br />Facility phone <br />209-825-7144 <br />Facility mailing address <br />300 N MAIN ST <br />MANTECA, CA 95336 <br />BILLING INFORMATION <br />Contact name <br />LUUS CHICKEN BOWL <br />Address <br />300 N MAIN ST <br />MANTECA, CA 95336 <br />Contact phone <br />Not Specified <br />Contact email <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />LUU, DAVID HOANG <br />111 <br />1010 E MARCH LN <br />113 <br />STOCKTON, CA 95210 <br />114, 115, 116 <br />2096013893 <br />112 <br />LUUS CHICKEN BOWL 3 <br />300 N MAIN ST 103 <br />MANTECA 104 <br />95336 105 <br />(209) 825-7144 102 <br />2010 ORVIS DR 108a <br />STOCKTON, CA 95209-4507 108b, 108c, 108d <br />LUUS CHICKEN BOWL 140 <br />2010 ORVIS DR 143 <br />STOCKTON, CA 95209-4507 144, 145, 146 <br />2096013893 141 <br />142 <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: 00v Date: <br />Accounting: Reviewed by: � Date: %l 1 7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[1 Acct b rguverifi'r?d 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 PRO161159 KADEANNE LINHARES Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0536823 KADEANNE LINHARES Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PRO536843 not assigned Inactive [ ] [ ] <br />