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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 10/5/2015 <br />Submitted on: 9/29/2015 4:16:OOPM <br />Submitted by: Helen Yeh Email: helen.yeh@pandarg.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 />OW0011593 <br />Panda Restaurant Group, Inc <br />1683 Walnut Grove Ave. <br />Rosemead, CA 91770 <br />626-799-9898 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0015113 <br />Facility name <br />PANDA EXPRESS #887 <br />Site address <br />5350 PACIFIC AVE STE J-1 <br />City <br />STOCKTON <br />ZIP code <br />95207 <br />Facility phone <br />209-476-1908 <br />Facility mailing address 1683 WALNUT GROVE AVE <br />CERS ID: 10643461 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Panda Restaurant Group, Inc. 111 <br />1683 Walnut Grove Ave. 113 <br />Rosemead, CA 91770 114, 115, 116 <br />(626) 799-9898 112 <br />PANDA EXPRESS #887 3 <br />5350 Pacific Ave Ste J1 103 <br />Stockton 104 <br />95207 105 <br />(209) 476-1908 102 <br />5350 Pacific Ave Ste J1 108a <br />Stockton, CA 95207 108b, 108c, 108d <br />Panda Restaurant Group, Inc. #887 140 <br />1683 Walnut Grove Ave. 143 <br />Rosemead, CA 91770 144, 145, 146 <br />(626) 372-8165 141 <br />helen.yeh@pandarg.com 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: Date: 0 1) ' i <br />Accounting: Reviewed by: bf' Date: oiia l Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[_}_Acet-bftte�urcharge verified--- 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 PR0522165 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location PR0530840 HAZA SAEED Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0531600 not assigned Inactive [ ] [ ] <br />ROSEMEAD, CA 91770 <br />BILLING INFORMATION <br />Contact name <br />PANDA EXPRESS #887 <br />Address <br />1683 WALNUT GROVE AVE <br />ROSEMEAD, CA 91770 <br />Contact phone <br />626-799-2331 <br />Contact email <br />Mail invoices to <br />Facjfity <br />CERS ID: 10643461 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />Panda Restaurant Group, Inc. 111 <br />1683 Walnut Grove Ave. 113 <br />Rosemead, CA 91770 114, 115, 116 <br />(626) 799-9898 112 <br />PANDA EXPRESS #887 3 <br />5350 Pacific Ave Ste J1 103 <br />Stockton 104 <br />95207 105 <br />(209) 476-1908 102 <br />5350 Pacific Ave Ste J1 108a <br />Stockton, CA 95207 108b, 108c, 108d <br />Panda Restaurant Group, Inc. #887 140 <br />1683 Walnut Grove Ave. 143 <br />Rosemead, CA 91770 144, 145, 146 <br />(626) 372-8165 141 <br />helen.yeh@pandarg.com 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: Date: 0 1) ' i <br />Accounting: Reviewed by: bf' Date: oiia l Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[_}_Acet-bftte�urcharge verified--- 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 PR0522165 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location PR0530840 HAZA SAEED Active [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0531600 not assigned Inactive [ ] [ ] <br />